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General NPI Number Information
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NPI Number | 1528957040
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Entity Type | Individual
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Provider Name | CLINTON E. PAYNE APRN
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Gender | Male
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 900 S 3RD ST
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City | MC GEHEE
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State | AR
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Zip | 71654-2562
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Country | US
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Telephone | 870-222-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 994 YOCUM RD
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City | LAKE VILLAGE
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State | AR
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Zip | 71653-7544
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Country | US
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Telephone | 870-814-9167
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 233971
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 233971
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License Number State | AR
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