Healthcare Provider Details

I. General information

NPI: 1639682065
Provider Name (Legal Business Name): ANGELINA PAYNE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W ARBROOK BLVD STE 301
ARLINGTON TX
76014-3180
US

IV. Provider business mailing address

400 W ARBROOK BLVD STE 301
ARLINGTON TX
76014-3180
US

V. Phone/Fax

Practice location:
  • Phone: 817-261-3000
  • Fax:
Mailing address:
  • Phone: 817-261-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA11606
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA11606
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: