1295195139 NPI number — MRS. CARA WEATHERFORD PAYNE OTR/L

Table of content: MRS. CARA WEATHERFORD PAYNE OTR/L (NPI 1295195139)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295195139 NPI number — MRS. CARA WEATHERFORD PAYNE OTR/L

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
PAYNE

Provider First Name:
CARA

Provider Middle Name:
WEATHERFORD

Provider Name Prefix Text:
MRS.

Provider Name Suffix Text:

Provider Credential Text:
OTR/L

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:
WEATHERFORD

Provider Other First Name:
CARA

Provider Other Middle Name:
NELLL

Provider Other Name Prefix Text:
MS.

Provider Other Name Suffix Text:

Provider Other Credential Text:
OTR/L

Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295195139

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
02/24/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
159 EXECUTIVE DR SUITE A

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
DANVILLE

Provider Business Mailing Address State Name:
VA

Provider Business Mailing Address Postal Code:
24541

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
434-799-7732

Provider Business Mailing Address Fax Number:
866-468-5040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
159 EXECUTIVE DR SUITE A

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
DANVILLE

Provider Business Practice Location Address State Name:
VA

Provider Business Practice Location Address Postal Code:
24541

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
434-799-7732

Provider Business Practice Location Address Fax Number:
866-468-5040

Provider Enumeration Date:
03/04/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

Provider Taxonomy Codes

Taxonomy code: 225XP0200X , with the licence number: 0119006889 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .