| Doctor Name: | DR. KELLY PAGE PALMER |
| NPI Number: | 1184780694 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | O-144 |
| Business Practice Address: | 700 East Alice Street Blackfoot, ID - 832210400 |
| Business Phone Number: | 2087858517 |
| Business Fax Number: | 2087858516 |
| Mailing Address: | Po Box 400, 700 East Alice BLACKFOOT |
| State: | ID |
| Postal Code: | 832210400 |
| Phone Number: | 2087858517 |
| Fax Number: | 2087858516 |
| NPI Enumeration Date: | 12/29/2006 |
| NPI Last Update Date: | 08/14/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084P0804X |
| License Number: | O-144 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Child & Adolescent Psychiatry |
| Taxonomy Definition: | Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |