Provider Demographics
NPI:1659790913
Name:PALACIOS, AUDREY (MSN, WHNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:AUDREY
Middle Name:
Last Name:PALACIOS
Suffix:
Gender:F
Credentials:MSN, WHNP-BC
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 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-2171
Mailing Address - Fax:956-362-2487
Practice Address - Street 1:2821 MICHAELANGELO DR
Practice Address - Street 2:STE 401
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1404
Practice Address - Country:US
Practice Address - Phone:956-362-2470
Practice Address - Fax:956-362-2487
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX781566363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX338707801Medicaid
TX365239YNG9Medicare PIN