Provider Demographics
NPI:1659924587
Name:PAYNE, JULIA (NP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 MOUNT MORIAH AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7834
Mailing Address - Country:US
Mailing Address - Phone:270-663-0955
Mailing Address - Fax:
Practice Address - Street 1:710 S GREEN RIVER RD STE 1
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4104
Practice Address - Country:US
Practice Address - Phone:812-901-5780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013537363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily