Provider Demographics
NPI:1174824023
Name:PALMER, JACQUELINE MARIE (ETC)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:MARIE
Last Name:PALMER
Suffix:
Gender:F
Credentials:ETC
Other - Prefix:
Other - First Name:NOT APPLICABLE
Other - Middle Name:NOT APPLICABLE
Other - Last Name:NOT APPLICABLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ETC
Mailing Address - Street 1:2434 SANDY FIELDS LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-2860
Mailing Address - Country:US
Mailing Address - Phone:646-279-7680
Mailing Address - Fax:
Practice Address - Street 1:2434 SANDY FIELDS LN
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-2860
Practice Address - Country:US
Practice Address - Phone:646-279-7680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172V00000X172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker