Provider Demographics
NPI:1457005308
Name:PAYNE, GRACE (MS, RD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 STUART AVE APT A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2313
Mailing Address - Country:US
Mailing Address - Phone:815-298-4575
Mailing Address - Fax:
Practice Address - Street 1:3408 STUART AVE APT A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2313
Practice Address - Country:US
Practice Address - Phone:815-298-4575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics