Provider Demographics
NPI:1992085401
Name:PAYTON, TOMEKA (ANP-BC)
Entity type:Individual
Prefix:MRS
First Name:TOMEKA
Middle Name:
Last Name:PAYTON
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:TOMEKA
Other - Middle Name:MCDOWELL
Other - Last Name:SAMPLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 GRACE DR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-9088
Mailing Address - Country:US
Mailing Address - Phone:864-269-3725
Mailing Address - Fax:864-679-3115
Practice Address - Street 1:101 GRACE DR
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-9088
Practice Address - Country:US
Practice Address - Phone:864-269-3725
Practice Address - Fax:864-679-3115
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17529363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health