1063638435 NPI number — JENS KERSTEN PALMER ANP-C

Table of content: JENS KERSTEN PALMER ANP-C (NPI 1063638435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063638435 NPI number — JENS KERSTEN PALMER ANP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALMER
Provider First Name:
JENS
Provider Middle Name:
KERSTEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ANP-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063638435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
293 OLMSTED BLVD
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
PINEHURST
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28374-9181
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-295-3200
Provider Business Mailing Address Fax Number:
910-295-3222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
293 OLMSTED BLVD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
PINEHURST
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28374-9181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-295-3200
Provider Business Practice Location Address Fax Number:
910-295-3222
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  5004433 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7000515 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com