Provider Demographics
NPI:1770867251
Name:PAYNE, PATRICIA DENISE
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DENISE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6895 SNYDER RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-7326
Mailing Address - Country:US
Mailing Address - Phone:901-258-7344
Mailing Address - Fax:
Practice Address - Street 1:3145 HICKORY HILL RD
Practice Address - Street 2:SUITE 106B
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-2518
Practice Address - Country:US
Practice Address - Phone:901-258-7344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child