Provider Demographics
NPI:1558784694
Name:PAYNE, TYRONE JR
Entity Type:Individual
Prefix:
First Name:TYRONE
Middle Name:
Last Name:PAYNE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1487 W KEISER AVE STE I
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:AR
Mailing Address - Zip Code:72370-2806
Mailing Address - Country:US
Mailing Address - Phone:870-563-4500
Mailing Address - Fax:
Practice Address - Street 1:1487 W KEISER AVE STE I
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:AR
Practice Address - Zip Code:72370-2806
Practice Address - Country:US
Practice Address - Phone:870-563-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-25
Last Update Date:2014-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator