=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184922502
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUSAN L PAYTON, ARNP, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2011
-----------------------------------------------------
Last Update Date | 03/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1640 PEAKS MILL RD
-----------------------------------------------------
City | FRANKFORT
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40601-8398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-229-1425
-----------------------------------------------------
Fax | 502-352-1226
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1640 PEAKS MILL RD
-----------------------------------------------------
City | FRANKFORT
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40601-8398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-229-1425
-----------------------------------------------------
Fax | 502-352-1226
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SUSAN PAYTON
-----------------------------------------------------
Credential | ARPN
-----------------------------------------------------
Telephone | 502-229-1425
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 4148P
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------