Individual provider Active NPI

Jackie Lynn Palmer, NP

  • Pediatric Nurse Practitioner
  • Indianapolis, IN
National Provider Identifier
1932988508
Registry record updated Nov 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
71014434A Issued in IN
Practice address
8402 Harcourt Rd Ste 830
Indianapolis, IN 46260-2096
Phone
(317) 338-8857
NPI assigned
Sep 25, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 28247258A IN
Pediatric Nurse Practitioner 363LP0200X 71014434A IN Primary

Addresses

Primary practice location

8402 Harcourt Rd Ste 830
Indianapolis, IN 46260-2096

Mailing address

8402 Harcourt Rd Ste 830
Indianapolis, IN 46260-2096

Other practice location 1

2001 W 86th St
Indianapolis, IN 46260-1902
Phone (317) 338-2345

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231208002787 IN Practitioner - Nurse Practitioner 2466801964 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
28247258AINMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Pediatric Subspecialties CurrentSince Nov 5, 2023 Accepting new patients
St Vincent Pediatric Subspecialties Pediatrics CurrentSince Nov 5, 2023 Accepting new patients

Locations

2001 W 86th St
Indianapolis, IN 46260
Phone (317) 338-3617

8402 Harcourt Rd
Ste 830
Indianapolis, IN 46260
Phone (317) 338-8857

250 W 96th St
Ste 520
Indianapolis, IN 46260
Phone (317) 583-3211

Interoperability endpoints

  • Direct secure messaging: jackie.palmer.1@7598.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1695600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700092800000",
    "number": "1932988508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8402 HARCOURT RD STE 830",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8402 HARCOURT RD STE 830",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602096",
            "telephone_number": "317-338-8857"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2001 W 86th St",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462601902",
            "country_code": "US",
            "telephone_number": "317-338-2345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PALMER",
        "first_name": "JACKIE",
        "middle_name": "LYNN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-25",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IN",
            "license": "28247258A",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IN",
            "license": "71014434A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.