Provider Demographics
NPI:1881791416
Name:PAYETTE, KAREN A (OPA-C)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:PAYETTE
Suffix:
Gender:F
Credentials:OPA-C
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:A
Other - Last Name:PROVENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9301 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0806
Mailing Address - Country:US
Mailing Address - Phone:214-220-2468
Mailing Address - Fax:214-397-1555
Practice Address - Street 1:9301 N CENTRAL EXPY
Practice Address - Street 2:SUITE 400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0806
Practice Address - Country:US
Practice Address - Phone:214-220-2468
Practice Address - Fax:214-397-1555
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX980363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant