Provider Demographics
NPI:1073309530
Name:PALMER, AMANDA NICOLE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:PALMER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 EZZELL RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-7212
Mailing Address - Country:US
Mailing Address - Phone:910-385-0311
Mailing Address - Fax:
Practice Address - Street 1:73 EZZELL RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-7212
Practice Address - Country:US
Practice Address - Phone:910-385-0311
Practice Address - Fax:910-385-0311
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251J00000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility