Provider Demographics
NPI:1356956262
Name:PAYNE, JESSICA ANN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
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:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:CHATTAROY
Mailing Address - State:WV
Mailing Address - Zip Code:25667-0325
Mailing Address - Country:US
Mailing Address - Phone:304-601-6404
Mailing Address - Fax:
Practice Address - Street 1:1203 BUFFALO CREEK ROAD
Practice Address - Street 2:LOT#1
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661
Practice Address - Country:US
Practice Address - Phone:304-601-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant