Provider Demographics
NPI:1932146859
Name:BRIAN M PAYNE APRN PSC
Entity type:Organization
Organization Name:BRIAN M PAYNE APRN PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-926-1650
Mailing Address - Street 1:2200 E PARRISH AVE
Mailing Address - Street 2: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: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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7026OtherMEDICARE GROUP
KY000000220259OtherANTHEM GROUP
KY7026OtherMEDICARE GROUP