Provider Demographics
NPI:1790347706
Name:PEYTON, RENITA LYNN (FNP)
Entity Type:Individual
Prefix:MISS
First Name:RENITA
Middle Name:LYNN
Last Name:PEYTON
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 1:5621 WILLOW TWIG LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-1151
Mailing Address - Country:US
Mailing Address - Phone:937-546-6588
Mailing Address - Fax:
Practice Address - Street 1:540 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-1110
Practice Address - Country:US
Practice Address - Phone:937-550-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025028363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily