Provider Demographics
NPI:1386478170
Name:PAYNE, RACHAL (RN)
Entity type:Individual
Prefix:
First Name:RACHAL
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 COLONIAL CIR
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8724
Mailing Address - Country:US
Mailing Address - Phone:417-720-0818
Mailing Address - Fax:
Practice Address - Street 1:5104 COLONIAL CIR
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-8724
Practice Address - Country:US
Practice Address - Phone:417-298-9743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012011702163WC0400X, 174400000X
2012011702332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies