1831525245 NPI number — MRS. ANDREA LEIGH PAYNE NP-C

Table of content: MRS. ANDREA LEIGH PAYNE NP-C (NPI 1831525245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831525245 NPI number — MRS. ANDREA LEIGH PAYNE NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAYNE
Provider First Name:
ANDREA
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP-C
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:
1831525245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1352
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SKAGWAY
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99840-1352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-488-2345
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1.7 DYEA ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SKAGWAY
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-488-2345
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2013

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: 363LF0000X , with the licence number:  154629 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Q025271 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".