Provider Demographics
NPI:1184713406
Name:PAYNE, KERRY DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:DANIEL
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1899 TATE BLVD SE STE 1105
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4200
Mailing Address - Country:US
Mailing Address - Phone:828-322-3821
Mailing Address - Fax:
Practice Address - Street 1:1899 TATE BLVD SE
Practice Address - Street 2:STE 1105
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4200
Practice Address - Country:US
Practice Address - Phone:828-322-3821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD29764207ZP0102X
FLME110975207ZP0102X
TN43145207ZP0102X
SC26429207ZP0102X
NC2008-00376207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology