Provider Demographics
NPI:1295365823
Name:HACKMANN, PAYTON SCOT (FNP-C)
Entity Type:Individual
Prefix:
First Name:PAYTON
Middle Name:SCOT
Last Name:HACKMANN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:PAYTON
Other - Middle Name:SCOT
Other - Last Name:SCHOOLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-4908
Practice Address - Fax:573-884-5184
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019047836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420089193Medicaid