Provider Demographics
NPI:1760804835
Name:PALMER, STACEY A (APRN)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:A
Last Name:PALMER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:A
Other - Last Name:TONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8119 CONNECTOR DR STE B
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1469
Mailing Address - Country:US
Mailing Address - Phone:859-283-2475
Mailing Address - Fax:859-283-0097
Practice Address - Street 1:8119 CONNECTOR DR STE B
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1469
Practice Address - Country:US
Practice Address - Phone:859-283-2475
Practice Address - Fax:859-283-0097
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704265423363LA2200X
KY3009046363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000905375OtherANTHEM
KY000000905375OtherANTHEM