Provider Demographics
NPI:1063771962
Name:PAYNE, CARLA S (RN, MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:S
Last Name:PAYNE
Suffix:
Gender:
Credentials:RN, MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6572 W CHARLESTON WAY
Mailing Address - Street 2:
Mailing Address - City:MCCORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-9677
Mailing Address - Country:US
Mailing Address - Phone:317-407-6808
Mailing Address - Fax:
Practice Address - Street 1:5999 W MEMORY LN STE 1
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-7294
Practice Address - Country:US
Practice Address - Phone:317-779-1204
Practice Address - Fax:317-940-5759
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28160871A163W00000X
IN71004088A363LP0808X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201085440Medicaid
IN300071854Medicaid
IN000000791892OtherANTHEM
IN000000779844OtherANTHEM
IN9360882OtherAETNA
IN9360882OtherAETNA