Provider Demographics
NPI:1336649987
Name:PALMER, COLTON A
Entity Type:Individual
Prefix:
First Name:COLTON
Middle Name:A
Last Name:PALMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10506 BURT CIR STE 160
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2009
Mailing Address - Country:US
Mailing Address - Phone:402-979-7128
Mailing Address - Fax:888-786-5514
Practice Address - Street 1:10506 BURT CIR STE 160
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2009
Practice Address - Country:US
Practice Address - Phone:402-979-7128
Practice Address - Fax:888-786-5514
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2045363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner