Provider Demographics
NPI:1558876391
Name:PALMER, DONDRIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:DONDRIA
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16954
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39236-6954
Mailing Address - Country:US
Mailing Address - Phone:601-779-1118
Mailing Address - Fax:769-572-5167
Practice Address - Street 1:109 OLD CANTON HILL DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-3337
Practice Address - Country:US
Practice Address - Phone:601-826-5702
Practice Address - Fax:769-572-5167
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS859947163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management