Healthcare Provider Details

I. General information

NPI: 1144130238
Provider Name (Legal Business Name): PALMER JAMES WARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BEVINS LN STE A
GEORGETOWN KY
40324-8532
US

IV. Provider business mailing address

138 ANNE JENNINGS WAY
GEORGETOWN KY
40324-6160
US

V. Phone/Fax

Practice location:
  • Phone: 502-863-0722
  • Fax: 502-863-0731
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4063067
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: