Provider Demographics
NPI:1447925425
Name:PALMER, JORDAN BAILEY (APRN-CNP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:BAILEY
Last Name:PALMER
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 BRIARMONT AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4796
Mailing Address - Country:US
Mailing Address - Phone:903-241-3884
Mailing Address - Fax:
Practice Address - Street 1:505 E NIFONG BLVD STE 107
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-3765
Practice Address - Country:US
Practice Address - Phone:573-615-1893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1049998363L00000X
MO2025007413363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner