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General NPI Number Information
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NPI Number | 1033326590
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Entity Type | Individual
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Provider Name | WILLETTA R.J. PALMER ARNP
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Gender | Female
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 4500 FOREST DR
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City | COLUMBIA
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State | SC
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Zip | 29206-3105
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Country | US
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Telephone | 803-738-9522
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 749306
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City | ATLANTA
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State | GA
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Zip | 30374-9306
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 21873
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 21873
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License Number State | SC
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