Provider Demographics
NPI:1003888629
Name:PALM, KEITH CHRISTOPHER (RN)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:CHRISTOPHER
Last Name:PALM
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Gender:M
Credentials:RN
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Mailing Address - Street 1:7922 BAYONET CIR
Mailing Address - Street 2:APT B
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4686
Mailing Address - Country:US
Mailing Address - Phone:719-559-4678
Mailing Address - Fax:719-526-3666
Practice Address - Street 1:USA MEDDAC, EVANS ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:1650 COCHRANE CIRCLE, ATTN: CREDENTIALS OFFICE
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4604
Practice Address - Country:US
Practice Address - Phone:719-526-7844
Practice Address - Fax:719-526-7984
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PARN505912L163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health