Provider Demographics
NPI:1598937211
Name:PAYNE, ABRA (LPN)
Entity Type:Individual
Prefix:
First Name:ABRA
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 OLD 63 S
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6065
Mailing Address - Country:US
Mailing Address - Phone:573-823-8986
Mailing Address - Fax:573-442-3538
Practice Address - Street 1:705 OLD 63 S
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6065
Practice Address - Country:US
Practice Address - Phone:573-823-8986
Practice Address - Fax:573-442-3538
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000170576164W00000X, 172A00000X, 374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No172A00000XOther Service ProvidersDriver