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 1:13027 STATE HIGHWAY 155 S
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-6560
Mailing Address - Country:US
Mailing Address - Phone:903-839-1000
Mailing Address - Fax:
Practice Address - Street 1:13027 STATE HIGHWAY 155 S
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-6560
Practice Address - Country:US
Practice Address - Phone:903-839-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1049998363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner