Provider Demographics
NPI:1386493922
Name:PAYTON, TANNEATHA KAYE
Entity type:Individual
Prefix:
First Name:TANNEATHA
Middle Name:KAYE
Last Name:PAYTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-5028
Mailing Address - Country:US
Mailing Address - Phone:254-317-6039
Mailing Address - Fax:
Practice Address - Street 1:2500 LIVENSHIRE DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-1400
Practice Address - Country:US
Practice Address - Phone:254-317-6039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator