Provider Demographics
NPI:1497778336
Name:PALMER, MARY LYNN (RN,WHNP, CA/CP SANE)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LYNN
Last Name:PALMER
Suffix:
Gender:F
Credentials:RN,WHNP, CA/CP SANE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:BOGATA
Mailing Address - State:TX
Mailing Address - Zip Code:75417-0367
Mailing Address - Country:US
Mailing Address - Phone:903-632-0078
Mailing Address - Fax:903-632-1825
Practice Address - Street 1:106 2ND ST NW
Practice Address - Street 2:
Practice Address - City:BOGATA
Practice Address - State:TX
Practice Address - Zip Code:75417-2451
Practice Address - Country:US
Practice Address - Phone:903-632-0078
Practice Address - Fax:903-632-1825
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX606498363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166184501Medicaid
TX8N7658OtherBLUE CROSS BLUE SHIELD
TX166184502Medicaid