Provider Demographics
NPI:1700499894
Name:PAYNE, AMANDA REBEKAH (MSN, RN, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:REBEKAH
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MSN, RN, AGPCNP-BC
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 110
Mailing Address - Street 2:
Mailing Address - City:CHILTON
Mailing Address - State:TX
Mailing Address - Zip Code:76632-0110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:540 CHAPEL DR
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-3490
Practice Address - Country:US
Practice Address - Phone:254-562-1454
Practice Address - Fax:254-562-1018
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX765618163W00000X
TX1007379363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse