Provider Demographics
NPI:1083151880
Name:PALMER, KATY (ARNP)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1924
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98328-1924
Mailing Address - Country:US
Mailing Address - Phone:360-832-2222
Mailing Address - Fax:360-859-9592
Practice Address - Street 1:320 CENTER STREET EAST
Practice Address - Street 2:
Practice Address - City:EATONVILLE
Practice Address - State:WA
Practice Address - Zip Code:98328-9832
Practice Address - Country:US
Practice Address - Phone:360-832-2222
Practice Address - Fax:360-859-9592
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60726677363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner