Provider Demographics
NPI:1346776150
Name:PAYNE, PATRICIA B (ANP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:B
Last Name:PAYNE
Suffix:
Gender:F
Credentials:ANP
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 871830
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-1830
Mailing Address - Country:US
Mailing Address - Phone:907-376-8938
Mailing Address - Fax:907-376-8939
Practice Address - Street 1:950 E BOGARD RD
Practice Address - Street 2:SUITE #228
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7184
Practice Address - Country:US
Practice Address - Phone:907-376-8938
Practice Address - Fax:907-376-8939
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK121579363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner