Provider Demographics
NPI:1649941907
Name:PAYNE, KURT A
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:A
Last Name:PAYNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 S HIAWASSEE RD APT 4432
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-8764
Mailing Address - Country:US
Mailing Address - Phone:786-457-5142
Mailing Address - Fax:
Practice Address - Street 1:2121 S HIAWASSEE RD APT 4432
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-8764
Practice Address - Country:US
Practice Address - Phone:786-457-5142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1160103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty