Provider Demographics
NPI:1932175122
Name:PAYNE, ANNETTE (RD)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 WHITE WATER LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6144
Mailing Address - Country:US
Mailing Address - Phone:404-754-3408
Mailing Address - Fax:
Practice Address - Street 1:1708 COIT RD
Practice Address - Street 2:UNIT 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-5024
Practice Address - Country:US
Practice Address - Phone:469-467-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83576133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6639Medicare ID - Type Unspecified