Healthcare Provider Details

I. General information

NPI: 1053495317
Provider Name (Legal Business Name): WILMA ARLENE PAYNE RN, ARNP, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 E LINWOOD BLVD
KANSAS CITY MO
64128-2226
US

IV. Provider business mailing address

4309 SW HICKORY LN
BLUE SPRINGS MO
64015-4518
US

V. Phone/Fax

Practice location:
  • Phone: 816-861-4700
  • Fax: 816-861-1110
Mailing address:
  • Phone: 816-861-4700
  • Fax: 816-861-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number0284281-05
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: