Provider Demographics
NPI:1558845065
Name:PALMER, REBECCA KRISTINE RAMOS (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:KRISTINE RAMOS
Last Name:PALMER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SUNDOWN RDG
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-6448
Mailing Address - Country:US
Mailing Address - Phone:217-671-6316
Mailing Address - Fax:
Practice Address - Street 1:11116 S TOWNE SQ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7850
Practice Address - Country:US
Practice Address - Phone:314-567-1958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013005218163W00000X
MO2019039931363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse