Healthcare Provider Details

I. General information

NPI: 1174903389
Provider Name (Legal Business Name): KASSANDRA L PAYNE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KASSANDRA L GUTHMUELLER DO

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4003 MASSARD RD
FORT SMITH AR
72903-6221
US

IV. Provider business mailing address

4003 MASSARD RD
FORT SMITH AR
72903-6221
US

V. Phone/Fax

Practice location:
  • Phone: 479-434-4747
  • Fax: 479-434-4949
Mailing address:
  • Phone: 479-434-4747
  • Fax: 479-434-4949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5982
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: