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General NPI Number Information
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NPI Number | 1306247630
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Entity Type | Individual
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Provider Name | CONNIE MARIE PALAKODETI FNP
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Gender | Female
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Dates
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Enumeration Date | 09/05/2014
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 2945 SCOTTSVILLE RD
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City | BOWLING GREEN
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State | KY
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Zip | 42104-6331
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Country | US
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Telephone | 270-783-3992
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 932958
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City | CLEVELAND
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State | OH
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Zip | 44193-0028
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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 | 4704367140
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN.CNP.18291
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4044151
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License Number State | KY
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