Jack Glen Palo

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

202 Sinclair Rd
Ellensburg, WA 98926-6590

Phone

(509) 306-0698

NPI assigned

Jun 1, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654041600000",
    "number": "1396484044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 SINCLAIR RD",
            "city": "ELLENSBURG",
            "state": "WA",
            "postal_code": "989266590",
            "telephone_number": "509-306-0698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 SINCLAIR RD",
            "city": "ELLENSBURG",
            "state": "WA",
            "postal_code": "989266590",
            "telephone_number": "509-306-0698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALO",
        "first_name": "JACK",
        "middle_name": "GLEN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-01",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Roby Pace III, M.D.
• Pacifica SL Ellensburg LLC
• Rebecca Palmer-Overmiller
• Robert Palmer
• Sarah Jean Palmer
• Carole T Parga, FNP
• Jennifer Anne Pariseau, MS, LMHC
• Annie Kay Park, ARNP FNP-C
• Kimberly M Parker, RN
• Michael Alan Patin, RPH

• Athletic Trainer in Ellensburg, WA
• Providers in Ellensburg, WA by specialty
• Athletic Trainer in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.