Provider Demographics
NPI:1588760409
Name:PALMER, JAY (CRNA)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:PALMER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 HOSPITAL RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9031
Mailing Address - Country:US
Mailing Address - Phone:740-779-8234
Mailing Address - Fax:740-779-7477
Practice Address - Street 1:1301 CARLISLE ST
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-1152
Practice Address - Country:US
Practice Address - Phone:724-226-7010
Practice Address - Fax:724-226-7404
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH327416367500000X
PARN656645367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2683592Medicaid