Healthcare Provider Details

I. General information

NPI: 1386478170
Provider Name (Legal Business Name): RACHAL PAYNE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5104 COLONIAL CIR
NIXA MO
65714-8724
US

IV. Provider business mailing address

5104 COLONIAL CIR
NIXA MO
65714-8724
US

V. Phone/Fax

Practice location:
  • Phone: 417-298-9743
  • Fax:
Mailing address:
  • Phone: 417-720-0818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2012011702
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number2012011702
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2012011702
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: