Provider Demographics
NPI:1205471778
Name:PAYNE, NEQUAN J
Entity type:Individual
Prefix:
First Name:NEQUAN
Middle Name:J
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 1:4204 LAC BIENVILLE DR APT D
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-5290
Mailing Address - Country:US
Mailing Address - Phone:504-345-3082
Mailing Address - Fax:
Practice Address - Street 1:4204 LAC BIENVILLE DR APT D
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-5290
Practice Address - Country:US
Practice Address - Phone:504-345-3082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator