Healthcare Provider Details

I. General information

NPI: 1770867251
Provider Name (Legal Business Name): PATRICIA DENISE PAYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 HICKORY HILL RD SUITE 106B
MEMPHIS TN
38115-2518
US

IV. Provider business mailing address

6895 SNYDER RD
MEMPHIS TN
38141-7326
US

V. Phone/Fax

Practice location:
  • Phone: 901-258-7344
  • Fax:
Mailing address:
  • Phone: 901-258-7344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: