Provider Demographics
NPI:1477758506
Name:PAYNE-BORDEN, JACQUELINE ANGELLA (PHD, APRN-PMH-BC)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ANGELLA
Last Name:PAYNE-BORDEN
Suffix:
Gender:F
Credentials:PHD, APRN-PMH-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6504 GRAINGER TERRACE
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3059
Mailing Address - Country:US
Mailing Address - Phone:240-988-6880
Mailing Address - Fax:
Practice Address - Street 1:14514 MAIN ST
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3059
Practice Address - Country:US
Practice Address - Phone:301-627-6816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR117769163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult