Provider Demographics
NPI:1851951180
Name:LAND, PAYDEN MORGAN (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:PAYDEN
Middle Name:MORGAN
Last Name:LAND
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 REID RD
Mailing Address - Street 2:
Mailing Address - City:JUNCTION
Mailing Address - State:TX
Mailing Address - Zip Code:76849-3049
Mailing Address - Country:US
Mailing Address - Phone:325-446-3305
Mailing Address - Fax:325-446-3990
Practice Address - Street 1:399 REID RD
Practice Address - Street 2:
Practice Address - City:JUNCTION
Practice Address - State:TX
Practice Address - Zip Code:76849-3049
Practice Address - Country:US
Practice Address - Phone:325-446-3305
Practice Address - Fax:325-446-3990
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13455363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX422518701Medicaid