Healthcare Provider Details

I. General information

NPI: 1083055800
Provider Name (Legal Business Name): TEDI E. PAYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 S STATE HIGHWAY 32
EL DORADO SPRINGS MO
64744-2302
US

IV. Provider business mailing address

1401 S PARK ST
EL DORADO SPRINGS MO
64744-2037
US

V. Phone/Fax

Practice location:
  • Phone: 417-876-3333
  • Fax: 417-876-4509
Mailing address:
  • Phone: 417-876-2511
  • Fax: 417-876-3812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2013018590
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: