Healthcare Provider Details

I. General information

NPI: 1265363097
Provider Name (Legal Business Name): ADRIANNA LEA PAYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 PROGRESS ST
MANY LA
71449-3313
US

IV. Provider business mailing address

160 PROGRESS ST
MANY LA
71449-3313
US

V. Phone/Fax

Practice location:
  • Phone: 318-508-1257
  • Fax:
Mailing address:
  • Phone: 318-508-1257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number012355274
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: