Provider Demographics
NPI:1386060218
Name:PAYNE, AMANDA KAY (APN)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:KAY
Last Name:PAYNE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 BAPTIST HEALTH DRIVE
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-664-4131
Mailing Address - Fax:501-975-1798
Practice Address - Street 1:9601 BAPTIST HEALTH DRIVE
Practice Address - Street 2:SUITE 1200
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-664-4131
Practice Address - Fax:501-975-1798
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004055363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR3485434P7MMedicare PIN