Provider Demographics
NPI:1174852040
Name:PALMER, SUSAN T (RD, LD, MPH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:T
Last Name:PALMER
Suffix:
Gender:F
Credentials:RD, LD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 CHURCHILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475
Mailing Address - Country:US
Mailing Address - Phone:859-623-5096
Mailing Address - Fax:859-624-1611
Practice Address - Street 1:229 CHURCHILL DRIVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475
Practice Address - Country:US
Practice Address - Phone:859-623-5096
Practice Address - Fax:859-624-1611
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0173133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered