MEDICARE: JORDYN PALMER

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	1026663	TX

General Provider Information

NPI Number	:	1659956712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDYN PALMER

Provider Business Mailing Address
First Line	:	10520 LAUREL MOUNTAIN LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-5047
Country	:	US
Telephone Number	:	915-227-4271
Fax Number	:

Provider Business Practice Location Address
First Line	:	10520 LAUREL MOUNTAIN LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-5047
Country	:	US
Telephone Number	:	915-227-4271
Fax Number	:

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

Provider Enumeration Date	:	03/10/2021
Last Update Date	:	03/10/2021

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Directions to “ JORDYN PALMER ” Practice Location

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