Provider Demographics
NPI:1386668440
Name:PALMER, DEANNA CAROL (ARNP)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:CAROL
Last Name:PALMER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 BROOKWATER LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6036
Mailing Address - Country:US
Mailing Address - Phone:859-271-4579
Mailing Address - Fax:
Practice Address - Street 1:1306 VERSAILLES ROAD
Practice Address - Street 2:STE 120
Practice Address - City:LEXINGTON
Practice Address - State:KENTUCKY
Practice Address - Zip Code:40504
Practice Address - Country:UM
Practice Address - Phone:859-259-0717
Practice Address - Fax:859-254-7874
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003262363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY310001118Medicaid
KY7100016340Medicaid
KY310001118Medicaid
KY7100016340Medicaid