Provider Demographics
NPI:1881213445
Name:PAYNE, JESSICA EVELYN (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:EVELYN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 J CLYDE MORRIS BLVD DEPT OF
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1929
Mailing Address - Country:US
Mailing Address - Phone:757-594-3945
Mailing Address - Fax:757-594-3184
Practice Address - Street 1:500 J CLYDE MORRIS BLVD DEPT OF
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1929
Practice Address - Country:US
Practice Address - Phone:757-594-3945
Practice Address - Fax:757-594-3184
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program