Provider Demographics
NPI:1962113290
Name:PAYNE, JOAN MARIAN (RDN, LDN)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIAN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8118 SHADY PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7345
Mailing Address - Country:US
Mailing Address - Phone:615-585-7697
Mailing Address - Fax:
Practice Address - Street 1:8118 SHADY PL
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7345
Practice Address - Country:US
Practice Address - Phone:615-585-7697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN446133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered