Healthcare Provider Details

I. General information

NPI: 1245480466
Provider Name (Legal Business Name): MS. BRIDGETTE PAYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SPRINGVIEW LN
SUMMERVILLE SC
29485-8154
US

IV. Provider business mailing address

207 HARTER DR
SUMMERVILLE SC
29485-4714
US

V. Phone/Fax

Practice location:
  • Phone: 843-832-5096
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number012747
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5990
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: