Provider Demographics
NPI:1134380934
Name:PAYNE, AMY RANAE
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:RANAE
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 1:12305 COUNTY ROAD 227
Mailing Address - Street 2:
Mailing Address - City:ORONOGO
Mailing Address - State:MO
Mailing Address - Zip Code:64855-9381
Mailing Address - Country:US
Mailing Address - Phone:417-525-4262
Mailing Address - Fax:
Practice Address - Street 1:12305 COUNTY ROAD 227
Practice Address - Street 2:
Practice Address - City:ORONOGO
Practice Address - State:MO
Practice Address - Zip Code:64855-9381
Practice Address - Country:US
Practice Address - Phone:417-525-4262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1702424174400000X
MO200602062174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist