Provider Demographics
NPI:1063638435
Name:PALMER, JENS KERSTEN (ANP-C)
Entity Type:Individual
Prefix:
First Name:JENS
Middle Name:KERSTEN
Last Name:PALMER
Suffix:
Gender:M
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 OLMSTED BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9181
Mailing Address - Country:US
Mailing Address - Phone:910-295-3200
Mailing Address - Fax:910-295-3222
Practice Address - Street 1:293 OLMSTED BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9181
Practice Address - Country:US
Practice Address - Phone:910-295-3200
Practice Address - Fax:910-295-3222
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004433363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000515Medicaid
NC7000515Medicaid