Provider Demographics
NPI:1366636763
Name:PAYNE, LYNNETTA FAITH (DO)
Entity Type:Individual
Prefix:DR
First Name:LYNNETTA
Middle Name:FAITH
Last Name:PAYNE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1717 HARPER RD
Mailing Address - Street 2:THIRD FLOOR SUITE A&B
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3373
Mailing Address - Country:US
Mailing Address - Phone:304-461-3879
Mailing Address - Fax:304-461-3858
Practice Address - Street 1:1717 HARPER RD
Practice Address - Street 2:THIRD FLOOR, SUITE A&B
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3373
Practice Address - Country:US
Practice Address - Phone:304-461-3879
Practice Address - Fax:304-461-0256
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV2330208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV1663AOtherMEDICARE PTAN
51D2046168OtherCLIA