Healthcare Provider Details

I. General information

NPI: 1316834260
Provider Name (Legal Business Name): EBONI DIONNE PALMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 BRYAN ST STE 900
DALLAS TX
75201-3140
US

IV. Provider business mailing address

6028 ARBOR BND APT 1222
FORT WORTH TX
76132-2926
US

V. Phone/Fax

Practice location:
  • Phone: 682-230-8774
  • Fax:
Mailing address:
  • Phone: 817-703-4295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: