Provider Demographics
NPI:1114147915
Name:PALMER, TERESA J (PA-C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:J
Last Name:PALMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-467-7150
Mailing Address - Fax:319-467-7140
Practice Address - Street 1:201 S CLINTON ST STE 168
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4034
Practice Address - Country:US
Practice Address - Phone:319-384-0520
Practice Address - Fax:319-384-0603
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002031363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1114147915Medicaid
IA1114147915Medicaid