Provider Demographics
NPI:1497575823
Name:PAYTE, REUBEN THOMAS (RN)
Entity type:Individual
Prefix:
First Name:REUBEN
Middle Name:THOMAS
Last Name:PAYTE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 TIMBER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HASKELL
Mailing Address - State:AR
Mailing Address - Zip Code:72015-7932
Mailing Address - Country:US
Mailing Address - Phone:407-493-5989
Mailing Address - Fax:
Practice Address - Street 1:208 TIMBER LAKE DR
Practice Address - Street 2:
Practice Address - City:HASKELL
Practice Address - State:AR
Practice Address - Zip Code:72015-7932
Practice Address - Country:US
Practice Address - Phone:407-493-5989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ARR086455163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program