Provider Demographics
NPI:1699256644
Name:PALMER, CHRISTY (APN)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:
Other - Last Name:SUHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:323 EDNA DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2210
Mailing Address - Country:US
Mailing Address - Phone:618-975-1186
Mailing Address - Fax:
Practice Address - Street 1:4173 CRESCENT DR STE A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1082
Practice Address - Country:US
Practice Address - Phone:314-858-5604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018024314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily