Provider Demographics
NPI:1821209974
Name:PAYNE, STEPHANIE KAY (PA-C, MPAS, RDCS)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:KAY
Last Name:PAYNE
Suffix:
Gender:F
Credentials:PA-C, MPAS, RDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:997 RAINTREE CIRCLE
Mailing Address - Street 2:STE 140
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013
Mailing Address - Country:US
Mailing Address - Phone:972-332-3366
Mailing Address - Fax:
Practice Address - Street 1:997 RAINTREE CIRCLE
Practice Address - Street 2:STE 140
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6103
Practice Address - Country:US
Practice Address - Phone:972-332-3366
Practice Address - Fax:972-332-3375
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05242363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant