Provider Demographics
NPI:1457741498
Name:PALMER, ROSHANN (CNP)
Entity Type:Individual
Prefix:
First Name:ROSHANN
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ROSHANN
Other - Middle Name:R
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:5151 REED RD STE 205
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2553
Mailing Address - Country:US
Mailing Address - Phone:614-865-3125
Mailing Address - Fax:614-273-0520
Practice Address - Street 1:5151 REED RD STE 205
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2553
Practice Address - Country:US
Practice Address - Phone:614-865-3125
Practice Address - Fax:614-273-0520
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.17051363LA2200X
FLAPRN11006888363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0118237Medicaid
OHH359821Medicare PIN