Provider Demographics
NPI:1043234149
Name:PAYNE, JANICE
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1440
Mailing Address - Street 2:
Mailing Address - City:CLINTWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24228-1440
Mailing Address - Country:US
Mailing Address - Phone:276-926-0200
Mailing Address - Fax:
Practice Address - Street 1:312 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24226-0312
Practice Address - Country:US
Practice Address - Phone:276-926-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017001384363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00206182OtherRAILROAD MEDICARE
TN0105OtherJOHN DEERE HEALTH
1218946OtherCHA HEALTH
VADC7419OtherRAILROAD MEDICARE GROUP #
VAC09011Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
P27480Medicare UPIN
VA005402D11Medicare ID - Type UnspecifiedTRAILBLAZER MEDICARE B