MEDICARE: FALLON L PALMER CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.020358	OH
2	363LF0000X	Family Nurse Practitioner	R200497	MD

General Provider Information

NPI Number	:	1407252919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FALLON L PALMER CRNP

Provider Business Mailing Address
First Line	:	PO BOX 7527
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-0727
Country	:	US
Telephone Number	:	614-544-6366
Fax Number	:	614-544-6350

Provider Business Practice Location Address
First Line	:	6096 E MAIN ST STE 106
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-4302
Country	:	US
Telephone Number	:	410-987-5244
Fax Number	:	410-729-7826

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2014
Last Update Date	:	02/25/2026

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