Provider Demographics
NPI:1497747836
Name:WALKER-PAYNE, KRISTEN L (CRNA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:WALKER-PAYNE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:L
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13307 MAGISTERIAL DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4212
Mailing Address - Country:US
Mailing Address - Phone:502-386-6501
Mailing Address - Fax:833-731-0413
Practice Address - Street 1:13307 MAGISTERIAL DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4212
Practice Address - Country:US
Practice Address - Phone:502-386-6501
Practice Address - Fax:833-731-0413
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNA10134367500000X
KY1076646163W00000X
TNRN0000112011367500000X
KY3003075367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74001363Medicaid
TN3632466Medicaid
KYP400020735Medicare PIN
KY74001363Medicaid