Provider Demographics
NPI:1598485567
Name:PAYNE, LATRINIA DANIELLE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LATRINIA
Middle Name:DANIELLE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 FALLEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6780
Mailing Address - Country:US
Mailing Address - Phone:601-341-0042
Mailing Address - Fax:
Practice Address - Street 1:544 KEYWAY DR STE A
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9580
Practice Address - Country:US
Practice Address - Phone:601-487-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905519363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health