Provider Demographics
NPI:1811674021
Name:PALMER, RODNEY GUY JR (PA-C)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:GUY
Last Name:PALMER
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELL
Mailing Address - State:WY
Mailing Address - Zip Code:82431-1513
Mailing Address - Country:US
Mailing Address - Phone:307-272-3228
Mailing Address - Fax:
Practice Address - Street 1:720 LINDSAY LN
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4142
Practice Address - Country:US
Practice Address - Phone:307-586-2506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT1131363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant