Provider Demographics
NPI:1184446601
Name:PAYNE, KEATON
Entity type:Individual
Prefix:
First Name:KEATON
Middle Name:
Last Name:PAYNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 E DUBLIN GRANVILLE RD STE 222K
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3338
Mailing Address - Country:US
Mailing Address - Phone:614-804-6003
Mailing Address - Fax:
Practice Address - Street 1:1395 E DUBLIN GRANVILLE RD STE 222K
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3338
Practice Address - Country:US
Practice Address - Phone:614-896-6003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator