Provider Demographics
NPI:1932196722
Name:PAYNE, BARBARA JEAN (RDLD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RDLD
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:JEAN
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7800 NW 85TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3385
Mailing Address - Country:US
Mailing Address - Phone:405-608-3800
Mailing Address - Fax:
Practice Address - Street 1:4050 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8382
Practice Address - Country:US
Practice Address - Phone:405-608-3800
Practice Address - Fax:405-608-3838
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK310133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200227170AMedicaid
OK200034910AMedicaid
OKP83452Medicare UPIN
OKOKA100681Medicare PIN
OK24H616510Medicare PIN
OKP83452Medicare UPIN