Provider Demographics
NPI:1003205527
Name:PAYNE, ANNA KRISTIN (RDN)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:KRISTIN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-3245
Mailing Address - Country:US
Mailing Address - Phone:540-797-4128
Mailing Address - Fax:
Practice Address - Street 1:943 SHORT ST
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-4256
Practice Address - Country:US
Practice Address - Phone:719-426-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1094814133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered