Provider Demographics
NPI:1124070289
Name:PAYNE, LYNELLE E (APN)
Entity type:Individual
Prefix:MRS
First Name:LYNELLE
Middle Name:E
Last Name:PAYNE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:LYNELLE
Other - Middle Name:E
Other - Last Name:ESAREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-935-1905
Mailing Address - Fax:765-935-1910
Practice Address - Street 1:1501 CHESTER BLVD
Practice Address - Street 2:REID URGENT CARE
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1914
Practice Address - Country:US
Practice Address - Phone:765-935-1905
Practice Address - Fax:765-935-1910
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000637A363LF0000X, 363LF0000X
ARA003806363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000843806OtherANTHEM
IN200373290Medicaid
IN200373290Medicaid
IN28075719AOtherRN
IN7100637AOtherNURSE PRACTITIONER
AR273342YJS9Medicare PIN