Provider Demographics
NPI:1215700349
Name:PAYNE, LEONTYNE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:LEONTYNE
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 MCCORKLE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-3022
Mailing Address - Country:US
Mailing Address - Phone:901-340-8049
Mailing Address - Fax:
Practice Address - Street 1:COLLEGE OF NURSING 874 UNION AVENUE RM 325
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-3022
Practice Address - Country:US
Practice Address - Phone:901-448-6128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN239569163WL0100X, 163WM0102X
374J00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No374J00000XNursing Service Related ProvidersDoula