Provider Demographics
NPI:1285930354
Name:PAYNE, BRENDA (ACNP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 AMBERTON PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3224
Mailing Address - Country:US
Mailing Address - Phone:682-236-3656
Mailing Address - Fax:
Practice Address - Street 1:9250 AMBERTON PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3224
Practice Address - Country:US
Practice Address - Phone:682-236-3656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP119849363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDQ5280OtherRR PALMETTO
TXD07564OtherMEDICARE RR PALMETTO
TXP00949091OtherPALMETTO RR
TX2845448-02Medicaid
TX895N44OtherBCBS
TX2035487-01Medicaid
TXD07564OtherMEDICARE RR PALMETTO
TXP00949091OtherPALMETTO RR
TX2035487-01Medicaid
TX311798YKP5Medicare PIN
TXDQ5280OtherRR PALMETTO