Healthcare Provider Details

I. General information

NPI: 1447916697
Provider Name (Legal Business Name): ASHLEY DAWN PAYNE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 S ADAIR ST
PRYOR OK
74361-3611
US

IV. Provider business mailing address

11928 S 4243 RD
CHELSEA OK
74016-3457
US

V. Phone/Fax

Practice location:
  • Phone: 918-964-0650
  • Fax:
Mailing address:
  • Phone: 918-964-0650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF10210201
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number205795
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: