1437431814 NPI number — KIMMIE LYNN PAYNE

Table of content: DR. JOHN KABIR LUEBS MD (NPI 1275160913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437431814 NPI number — KIMMIE LYNN PAYNE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAYNE
Provider First Name:
KIMMIE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437431814
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 ASPEN PEAK LOOP
Provider Second Line Business Mailing Address:
APT 222
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89011-1840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-752-9315
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 ASPEN PEAK LOOP
Provider Second Line Business Practice Location Address:
APT 222
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89011-1840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-752-9315
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2011

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)