Healthcare Provider Details

I. General information

NPI: 1558845065
Provider Name (Legal Business Name): REBECCA KRISTINE RAMOS PALMER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11116 S TOWNE SQ
SAINT LOUIS MO
63123-7850
US

IV. Provider business mailing address

109 SUNDOWN RDG
MARYVILLE IL
62062-6448
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-1958
  • Fax:
Mailing address:
  • Phone: 217-671-6316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2013005218
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2019039931
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: