Healthcare Provider Details

I. General information

NPI: 1518079649
Provider Name (Legal Business Name): KENNETH J PAYNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S FLOYD ST STE 300
LOUISVILLE KY
40202-1837
US

IV. Provider business mailing address

1104 SHADY LN
LOUISVILLE KY
40223-2256
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-1515
  • Fax: 502-629-1545
Mailing address:
  • Phone: 502-797-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number40305
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number40305
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: