Provider Demographics
NPI:1760785869
Name:PALMER, MEGAN (CM)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 S ELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-4208
Mailing Address - Country:US
Mailing Address - Phone:918-587-3888
Mailing Address - Fax:918-587-3891
Practice Address - Street 1:1608 S ELWOOD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-4208
Practice Address - Country:US
Practice Address - Phone:918-587-3888
Practice Address - Fax:918-587-3891
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22896171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator