Healthcare Provider Details

I. General information

NPI: 1942019724
Provider Name (Legal Business Name): RAYNI NICOLE PAYNE AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E BROADWAY STE 240
COLUMBIA MO
65201-8022
US

IV. Provider business mailing address

1601 E BROADWAY STE 240
COLUMBIA MO
65201-8022
US

V. Phone/Fax

Practice location:
  • Phone: 573-815-8145
  • Fax: 573-815-3832
Mailing address:
  • Phone: 573-815-8145
  • Fax: 573-815-3832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2019003025
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: