Provider Demographics
NPI:1487245429
Name:PALMER, CHARLENE JOAN
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:JOAN
Last Name:PALMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 N MUELLER AVE
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-3951
Mailing Address - Country:US
Mailing Address - Phone:405-473-1849
Mailing Address - Fax:
Practice Address - Street 1:3513 N MUELLER AVE
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-3951
Practice Address - Country:US
Practice Address - Phone:405-473-1849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator