MEDICARE: MS. JENICE DIANE PALACHICK 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	363L00000X	Nurse Practitioner	SP010477	PA
2	363LF0000X	Family Nurse Practitioner	0024185916	VA
3	363LF0000X	Family Nurse Practitioner	SP010477	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00802876	OTHER	PA	RAILROAD MEDICARE
7	679M	OTHER	MD	MEDICARE GROUP #
9	867633	OTHER	PA	MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	25-1716306	OTHER	PA	HEALTHNET/TRICARE
3	25-1716306	OTHER	PA	INTERGROUP
5	25-1716306	OTHER	PA	DEVON
6	50090234	OTHER	PA	CAPITAL BLUECROSS
8	25-1716306	OTHER	PA	MULTIPLAN/PHCS
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	SP010477	OTHER	PA	LICENSE

General Provider Information

NPI Number	:	1922336452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENICE DIANE PALACHICK CRNP

Provider Business Mailing Address
First Line	:	213 S JEFFERSON ST STE 1006
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24011-1713
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4035 ELECTRIC RD STE A
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-8449
Country	:	US
Telephone Number	:	540-772-8670
Fax Number	:

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

Provider Enumeration Date	:	11/20/2009
Last Update Date	:	09/19/2025

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