Provider Demographics
NPI:1114504016
Name:PALMGREN, KATHERINE SMITH (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SMITH
Last Name:PALMGREN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:DAWN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7400 CARMEL EXECUTIVE PARK DR STE 155
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8242
Mailing Address - Country:US
Mailing Address - Phone:828-350-1177
Mailing Address - Fax:828-350-1188
Practice Address - Street 1:7400 CARMEL EXECUTIVE PARK DR STE 155
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8242
Practice Address - Country:US
Practice Address - Phone:828-350-1177
Practice Address - Fax:828-350-1188
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014369363LP0808X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program