Provider Demographics
NPI:1205665577
Name:PAYNE NURSING SERVICES, LLC
Entity type:Organization
Organization Name:PAYNE NURSING SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:317-779-1204
Mailing Address - Street 1:6572 W CHARLESTON WAY
Mailing Address - Street 2:
Mailing Address - City:MCCORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-9677
Mailing Address - Country:US
Mailing Address - Phone:317-779-1204
Mailing Address - Fax:317-940-5759
Practice Address - Street 1:5999 W MEMORY LN STE 1
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-7294
Practice Address - Country:US
Practice Address - Phone:317-779-1204
Practice Address - Fax:317-940-5759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300097015Medicaid
IN201085440Medicaid