Provider Demographics
NPI:1902642457
Name:PAYNE, KELSEY (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 OLIVETO VERDI CT
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6655
Mailing Address - Country:US
Mailing Address - Phone:812-459-2438
Mailing Address - Fax:
Practice Address - Street 1:1001 OLIVETO VERDI CT
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6655
Practice Address - Country:US
Practice Address - Phone:812-459-2438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11034468363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily