Provider Demographics
NPI:1356385504
Name:PALMER, WARDEN LAMAR (APRN)
Entity type:Individual
Prefix:MR
First Name:WARDEN
Middle Name:LAMAR
Last Name:PALMER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1802 E 50TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79404
Mailing Address - Country:US
Mailing Address - Phone:806-771-1160
Mailing Address - Fax:806-771-1162
Practice Address - Street 1:1802 E 50TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79404
Practice Address - Country:US
Practice Address - Phone:806-771-1160
Practice Address - Fax:806-771-1162
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX578145363L00000X, 364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1356385504OtherNPI