Provider Demographics
NPI:1770777237
Name:PAYNE, JERI (APRN)
Entity type:Individual
Prefix:MS
First Name:JERI
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WARM SPRINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59756
Mailing Address - Country:US
Mailing Address - Phone:406-693-7011
Mailing Address - Fax:406-693-7069
Practice Address - Street 1:1 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:MT
Practice Address - Zip Code:59756
Practice Address - Country:US
Practice Address - Phone:406-693-7011
Practice Address - Fax:406-693-7069
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN013335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTS44145Medicare UPIN