Provider Demographics
NPI:1275340747
Name:PAYNE, TESSA LAVON
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:LAVON
Last Name:PAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 S YALE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6319
Mailing Address - Country:US
Mailing Address - Phone:918-998-8722
Mailing Address - Fax:
Practice Address - Street 1:306 N 20TH ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-1607
Practice Address - Country:US
Practice Address - Phone:918-998-8722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist