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General NPI Number Information
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NPI Number | 1235612706
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Entity Type | Individual
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Provider Name | PEACHES PALMER NP
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Gender | Female
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Dates
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Enumeration Date | 09/11/2018
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Last Update Date | 09/11/2018
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Provider Practice Location Address
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Address Line | 3661 SANGANI BLVD STE E
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City | DIBERVILLE
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State | MS
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Zip | 39540-8707
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Country | US
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Telephone | 228-354-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 803 DARIUS DR
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City | BILOXI
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State | MS
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Zip | 39532-2700
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Country | US
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Telephone | 228-380-2059
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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 | F06180040
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License Number State | MS
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