Provider Demographics
NPI:1356130256
Name:PALMER, JERRY EDWARD EDWARD II
Entity type:Individual
Prefix:MR
First Name:JERRY EDWARD
Middle Name:EDWARD
Last Name:PALMER
Suffix:II
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7399 TOURNAMENT DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-7708
Mailing Address - Country:US
Mailing Address - Phone:636-288-4794
Mailing Address - Fax:636-288-4794
Practice Address - Street 1:7399 TOURNAMENT DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-7708
Practice Address - Country:US
Practice Address - Phone:636-288-4794
Practice Address - Fax:636-288-4794
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide