Provider Demographics
NPI:1285244277
Name:HANNON, PAYTON MARYJEAN (FNP)
Entity type:Individual
Prefix:
First Name:PAYTON
Middle Name:MARYJEAN
Last Name:HANNON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:COBLESKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12043-5150
Mailing Address - Country:US
Mailing Address - Phone:315-625-4034
Mailing Address - Fax:518-234-3415
Practice Address - Street 1:136 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-5150
Practice Address - Country:US
Practice Address - Phone:518-234-2555
Practice Address - Fax:518-234-2555
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347770207Q00000X, 363LF0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program