Provider Demographics
NPI:1639185754
Name:PAYNE, CONCETTA LETITIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:CONCETTA
Middle Name:LETITIA
Last Name:PAYNE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14202 PONEAL CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-2184
Mailing Address - Country:US
Mailing Address - Phone:281-345-8264
Mailing Address - Fax:
Practice Address - Street 1:14202 PONEAL CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-2184
Practice Address - Country:US
Practice Address - Phone:281-345-8264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX681356363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health