Provider Demographics
NPI:1912778275
Name:OKELLY, PAYTON MARIE (NP)
Entity Type:Individual
Prefix:
First Name:PAYTON
Middle Name:MARIE
Last Name:OKELLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PAYTON
Other - Middle Name:MARIE
Other - Last Name:ARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:938 YUCCA CT
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8422
Mailing Address - Country:US
Mailing Address - Phone:682-554-7096
Mailing Address - Fax:
Practice Address - Street 1:938 YUCCA CT
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8422
Practice Address - Country:US
Practice Address - Phone:682-554-7096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1141972363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner