Provider Demographics
NPI:1508092818
Name:PAYNE, REBECCA JEAN (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:JEAN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:281 NORTH LYERLY STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404
Mailing Address - Country:US
Mailing Address - Phone:423-693-2175
Mailing Address - Fax:888-959-1015
Practice Address - Street 1:281 NORTH LYERLY STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-693-2175
Practice Address - Fax:888-959-1015
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I977412Medicare PIN