Provider Demographics
NPI:1659616837
Name:PALMER, JASON RICHARD (PA-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:RICHARD
Last Name:PALMER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106151 E. STREET
Mailing Address - Street 2:BLDG # H100
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78419
Mailing Address - Country:US
Mailing Address - Phone:361-961-2986
Mailing Address - Fax:
Practice Address - Street 1:10651 E ST BLDG H100
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78419-5130
Practice Address - Country:US
Practice Address - Phone:361-961-2986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004797363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical