Provider Demographics
NPI:1679288799
Name:PAYNE, EMILY J (FNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:PAYNE
Suffix:
Gender:F
Credentials:FNP
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 266
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47842-0266
Mailing Address - Country:US
Mailing Address - Phone:765-832-9301
Mailing Address - Fax:765-832-9302
Practice Address - Street 1:819 S 3RD ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IN
Practice Address - Zip Code:47842-2205
Practice Address - Country:US
Practice Address - Phone:765-832-2464
Practice Address - Fax:765-832-1638
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013496A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71013496AOtherSTATE LICENSE