Provider Demographics
NPI:1659334084
Name:PALMER, CATHERINE A (RD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:PALMER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:A
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:5757 W HEFNER RD
Mailing Address - Street 2:#508
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-5850
Mailing Address - Country:US
Mailing Address - Phone:405-721-7629
Mailing Address - Fax:
Practice Address - Street 1:1 S BRYANT AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6309
Practice Address - Country:US
Practice Address - Phone:405-341-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1091133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK248407304Medicare ID - Type Unspecified