Provider Demographics
NPI:1760989073
Name:PAYNE, WILLIAM JASON (APRN)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JASON
Last Name:PAYNE
Suffix:
Gender:M
Credentials:APRN
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Mailing Address - Street 1:1060 BROADWAY
Mailing Address - Street 2:#3032
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12204
Mailing Address - Country:US
Mailing Address - Phone:518-400-2715
Mailing Address - Fax:518-519-3331
Practice Address - Street 1:1060 BROADWAY
Practice Address - Street 2:#3032
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204
Practice Address - Country:US
Practice Address - Phone:518-400-2715
Practice Address - Fax:518-519-3331
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2022-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN24256363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty