Provider Demographics
NPI:1598922973
Name:LAIRD-PAYNE, AMY CATHERINE (PYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:CATHERINE
Last Name:LAIRD-PAYNE
Suffix:
Gender:F
Credentials:PYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650859 DEPT 710
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-6263
Mailing Address - Country:US
Mailing Address - Phone:409-772-0620
Mailing Address - Fax:
Practice Address - Street 1:208 OAK DR S STE 400A
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5640
Practice Address - Country:US
Practice Address - Phone:979-285-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03960363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant