Provider Demographics
NPI:1366058422
Name:PAYNE, JEREMY MICHAEL (APRN)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:MICHAEL
Last Name:PAYNE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-2175
Mailing Address - Country:US
Mailing Address - Phone:270-314-0733
Mailing Address - Fax:270-240-1227
Practice Address - Street 1:3110 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-2175
Practice Address - Country:US
Practice Address - Phone:270-314-0733
Practice Address - Fax:270-240-1227
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013528363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily