Provider Demographics
NPI:1316715667
Name:PALMER, CASEY JORDAN (RN)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:JORDAN
Last Name:PALMER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-7235
Mailing Address - Country:US
Mailing Address - Phone:276-780-0069
Mailing Address - Fax:
Practice Address - Street 1:1718 CONCORD ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-7235
Practice Address - Country:US
Practice Address - Phone:276-780-0069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001251510163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse