Provider Demographics
NPI:1558475731
Name:PAYNE, CHANDRA (ARNP)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CHAMBLISS DR
Mailing Address - Street 2:
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143-2575
Mailing Address - Country:US
Mailing Address - Phone:270-756-2424
Mailing Address - Fax:270-756-2525
Practice Address - Street 1:105 CHAMBLISS DR
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-2575
Practice Address - Country:US
Practice Address - Phone:270-756-2424
Practice Address - Fax:270-756-2525
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3651P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78006988Medicaid
IN200404730Medicaid
KY78006988Medicaid
IN200404730Medicaid