Provider Demographics
NPI:1407442882
Name:PAYNE, KENDRA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5354 HIGH PLAINS PL
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-5232
Mailing Address - Country:US
Mailing Address - Phone:719-250-4189
Mailing Address - Fax:
Practice Address - Street 1:5354 HIGH PLAINS PL
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-5232
Practice Address - Country:US
Practice Address - Phone:719-250-4189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996105-NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care