Provider Demographics
NPI:1619040193
Name:PALMER, JOANNE MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:MARIE
Last Name:PALMER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:MARIE
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:425 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ORDERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84758
Mailing Address - Country:US
Mailing Address - Phone:435-648-2775
Mailing Address - Fax:435-648-2779
Practice Address - Street 1:355 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KANAB
Practice Address - State:UT
Practice Address - Zip Code:84741-3260
Practice Address - Country:US
Practice Address - Phone:435-648-2775
Practice Address - Fax:435-648-2779
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6040302363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT86749OtherPEHP
UT60403024400001OtherBCBS
UTD6629Medicaid
UTD6629Medicaid
UT86749OtherPEHP