Healthcare Provider Details

I. General information

NPI: 1811844228
Provider Name (Legal Business Name): SAMANTHA PAYNE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

13101 W MISSISSIPPI CT APT 109
LAKEWOOD CO
80228-3470
US

V. Phone/Fax

Practice location:
  • Phone: 336-406-5180
  • Fax:
Mailing address:
  • Phone: 336-406-5180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14275612-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0001295568
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: