Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | F381408-1 | NY |
NPI | 1043293228 |
---|---|
Provider Name | Mrs. Kimberly Ann Palmer |
First Address | Locust Valley, NY 11560-1929 |
Second Address | New York, NY 10013-1510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 08/07/2007 |