Healthcare Provider Details

I. General information

NPI: 1215700349
Provider Name (Legal Business Name): LEONTYNE PAYNE RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COLLEGE OF NURSING 874 UNION AVENUE RM 325
MEMPHIS TN
38163-3022
US

IV. Provider business mailing address

3250 MCCORKLE RD
MEMPHIS TN
38116-3022
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-6128
  • Fax:
Mailing address:
  • Phone: 901-340-8049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number239569
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number239569
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: