Provider Demographics
NPI:1831525245
Name:PAYNE, ANDREA LEIGH (NP-C)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LEIGH
Last Name:PAYNE
Suffix:
Gender:F
Credentials:NP-C
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 1352
Mailing Address - Street 2:
Mailing Address - City:SKAGWAY
Mailing Address - State:AK
Mailing Address - Zip Code:99840-1352
Mailing Address - Country:US
Mailing Address - Phone:423-488-2345
Mailing Address - Fax:
Practice Address - Street 1:1.7 DYEA ROAD
Practice Address - Street 2:
Practice Address - City:SKAGWAY
Practice Address - State:AK
Practice Address - Zip Code:99840
Practice Address - Country:US
Practice Address - Phone:423-488-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK154629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ025271Medicaid