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General NPI Number Information
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NPI Number | 1790602175
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Entity Type | Individual
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Provider Name | JACOB PAYNE
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Gender | Male
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Dates
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Enumeration Date | 07/06/2026
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Last Update Date | 07/06/2026
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Provider Practice Location Address
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Address Line | 4342 JAMES MADISON HWY
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City | FORK UNION
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State | VA
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Zip | 23055-2025
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Country | US
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Telephone | 143-420-4980
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Fax |
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Provider Business Mailing Address
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Address Line | 945 JEFFERSON DR
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City | PALMYRA
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State | VA
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Zip | 22963-3313
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024197991
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License Number State | VA
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