Healthcare Provider Details

I. General information

NPI: 1063806933
Provider Name (Legal Business Name): JAMES NATHAN PAYNE NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5090 GAUTIER VANCLEAVE RD
GAUTIER MS
39553-4803
US

IV. Provider business mailing address

1604 BEACH VIEW DRIVE
OCEAN SPRINGS MS
39564
US

V. Phone/Fax

Practice location:
  • Phone: 228-522-6700
  • Fax: 228-522-3383
Mailing address:
  • Phone: 228-219-6706
  • Fax: 228-522-3383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR865473
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: