Provider Demographics
NPI:1598492985
Name:PAYNE, VANESSA VANOVER (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:VANOVER
Last Name:PAYNE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 TUSCANY DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-5233
Mailing Address - Country:US
Mailing Address - Phone:361-542-6152
Mailing Address - Fax:
Practice Address - Street 1:317 TUSCANY DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-5233
Practice Address - Country:US
Practice Address - Phone:361-542-6152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX927849163W00000X
TX1107112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse