Provider Demographics
NPI:1174932347
Name:PALMER, KATHLEEN L (APN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:L
Last Name:PALMER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 HOOPER AVENUE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8321
Mailing Address - Country:US
Mailing Address - Phone:732-349-8866
Mailing Address - Fax:732-349-7842
Practice Address - Street 1:3499 ROUTE 9 N
Practice Address - Street 2:SUITE 2B
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-3258
Practice Address - Country:US
Practice Address - Phone:732-625-3166
Practice Address - Fax:732-409-7473
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00516300363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health