Provider Demographics
NPI:1316834260
Name:PALMER, EBONI DIONNE
Entity type:Individual
Prefix:
First Name:EBONI
Middle Name:DIONNE
Last Name:PALMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6028 ARBOR BND APT 1222
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-2926
Mailing Address - Country:US
Mailing Address - Phone:817-703-4295
Mailing Address - Fax:
Practice Address - Street 1:1999 BRYAN ST STE 900
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-3140
Practice Address - Country:US
Practice Address - Phone:682-230-8774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach