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General NPI Number Information
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NPI Number | 1700499894
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Entity Type | Individual
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Provider Name | AMANDA REBEKAH PAYNE MSN, RN, AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 540 CHAPEL DR
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City | MEXIA
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State | TX
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Zip | 76667-3490
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Country | US
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Telephone | 254-562-1454
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Fax | 254-562-1018
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Provider Business Mailing Address
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Address Line | PO BOX 110
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City | CHILTON
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State | TX
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Zip | 76632-0110
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 765618
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 1007379
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License Number State | TX
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