Provider Demographics
NPI:1588896823
Name:PAYNE, BRIAN M (ARNP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:PAYNE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E PARRISH AVE
Mailing Address - Street 2:BLD. B, STE. 202
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-926-1650
Mailing Address - Fax:270-926-1671
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:BLD. B, STE. 202
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-926-1650
Practice Address - Fax:270-926-1671
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6140P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily