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General NPI Number Information
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NPI Number | 1992462725
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Entity Type | Individual
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Provider Name | KELSEY JORDAN PALMER OD
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Gender | Female
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Dates
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Enumeration Date | 11/29/2021
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 18431 N 91ST AVE STE 1
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City | PEORIA
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State | AZ
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Zip | 85382-0817
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Country | US
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Telephone | 623-393-8324
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Fax |
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Provider Business Mailing Address
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Address Line | 18431 N 91ST AVE STE 1
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City | PEORIA
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State | AZ
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Zip | 85382-0817
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Country | US
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Telephone | 623-393-8324
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TA2920
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5539
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT-002579
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODP-100623
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License Number State | ID
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | I5-0000005
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License Number State | DE
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Taxonomy #6
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1058
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License Number State | NH
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Taxonomy #7
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TPOP102
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License Number State | FL
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Taxonomy #8
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT.0003933
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License Number State | CO
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Taxonomy #9
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 13429536-9934
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License Number State | UT
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Taxonomy #10
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 009499
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License Number State | NY
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