Individual
MARY PALMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
57 DORA LN, GREENUP, KY 41144-1187
(606) 473-7333
(606) 473-7335
Mailing address
PO BOX 790, ASHLAND, KY 41105-0790
(606) 329-8588
(606) 329-8195
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1034324
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000389967
ANTHEM BCBS
—
01
—
11638248
CAQH
—
05
—
30610026
—
KY
Enumeration date
08/28/2006
Last updated
11/10/2014
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