MEDICARE: ASHLI PALMER FNP

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	5009409	NC

General Provider Information

NPI Number	:	1861923302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLI PALMER FNP

Provider Business Mailing Address
First Line	:	5110 PARK RD
Second Line	:	SUITE 1J
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3699
Country	:	US
Telephone Number	:	704-496-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	5110 PARK RD
Second Line	:	SUITE 1J
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3699
Country	:	US
Telephone Number	:	704-496-9100
Fax Number	:

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

Provider Enumeration Date	:	03/26/2017
Last Update Date	:	03/26/2017

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