Provider Demographics
NPI:1598197873
Name:PAYNE, LOREN (CRNA)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LOREN
Other - Middle Name:
Other - Last Name:CHASTAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:765 EBLEN CIR
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-3510
Mailing Address - Country:US
Mailing Address - Phone:423-506-2340
Mailing Address - Fax:
Practice Address - Street 1:9352 PARK WEST BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4325
Practice Address - Country:US
Practice Address - Phone:865-373-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN160245163W00000X
TN101131367500000X
TN18333367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse