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Individual

DR. KELLY PAGE PALMER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
700 EAST ALICE STREET, BLACKFOOT, ID 83221-0400
(208) 785-8517
(208) 785-8516
Mailing address
PO BOX 400, 700 EAST ALICE, BLACKFOOT, ID 83221-0400
(208) 785-8517
(208) 785-8516

Taxonomy

Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
O-144
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003398400
ID
05
0033991
ID
Enumeration date
12/29/2006
Last updated
08/14/2012
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