Provider Demographics
NPI:1528206893
Name:PALMER, RYAN (ATC)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:PALMER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11738 COUNTY ROAD 160
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-7299
Mailing Address - Country:US
Mailing Address - Phone:417-358-5246
Mailing Address - Fax:
Practice Address - Street 1:2727 MCCLELLAND BLVD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1626
Practice Address - Country:US
Practice Address - Phone:417-625-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-25
Last Update Date:2009-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOB-57967146N00000X
MO1194832255A2300X
OK5302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic