Provider Demographics
NPI:1184922502
Name:SUSAN L PAYTON, ARNP, PLLC
Entity type:Organization
Organization Name:SUSAN L PAYTON, ARNP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:ARPN
Authorized Official - Phone:502-229-1425
Mailing Address - Street 1:1640 PEAKS MILL RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-8398
Mailing Address - Country:US
Mailing Address - Phone:502-229-1425
Mailing Address - Fax:502-352-1226
Practice Address - Street 1:1640 PEAKS MILL RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-8398
Practice Address - Country:US
Practice Address - Phone:502-229-1425
Practice Address - Fax:502-352-1226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4148P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP99773Medicare UPIN