Provider Demographics
NPI:1700831138
Name:PAYNE, ELIZABETH DIANE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:DIANE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10821 PLANTSIDE DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299
Mailing Address - Country:US
Mailing Address - Phone:502-412-2995
Mailing Address - Fax:502-412-8025
Practice Address - Street 1:10821 PLANTSIDE DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299
Practice Address - Country:US
Practice Address - Phone:502-412-2995
Practice Address - Fax:502-412-8025
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002826363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY500028827OtherPASSPORT PROV NUMBER
KY7765491OtherAETNA PIN
KY78028263Medicaid
IN201016000Medicaid
KY2444184000OtherPASSPORT ADVANTAGE
KY000000240200OtherANTHEM PROV NUMBER
KY000000240200OtherANTHEM PROV NUMBER
KY2444184000OtherPASSPORT ADVANTAGE
IN201016000Medicaid
KYP400035642Medicare PIN