Active NPI
Ida Marie Palmer
- Health Psychologist
- Jacksonville, FL
National Provider Identifier
1992362404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Psychologist
- License
- 103TH0100X
- Practice address
- 6722 Arlington Expy # 570
Jacksonville, FL 32211-7234 - Phone
- (904) 601-8426
- NPI assigned
- May 21, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Psychologist | 103TH0004X | 103TH0100X | FL | Primary |
Addresses
Primary practice location
6722 Arlington Expy # 570
Jacksonville, FL 32211-7234
Mailing address
6722 Arlington Expy # 570
Jacksonville, FL 32211-7234
Phone (904) 601-8426
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G18000033026 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103TH0100X | FL | MD | Health Service Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558396800000",
"number": "1992362404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6722 ARLINGTON EXPY # 570",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322117234",
"telephone_number": "904-601-8426"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6722 ARLINGTON EXPY # 570",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322117234",
"telephone_number": "904-601-8426"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PALMER",
"first_name": "IDA",
"middle_name": "MARIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-21",
"last_updated": "2019-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TH0004X",
"taxonomy_group": "",
"desc": "Psychologist, Health",
"state": "FL",
"license": "103TH0100X",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "G18000033026",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.