MEDICARE: MS. ANISSA NICOLE PAYNE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	174H00000X	Health Educator
2	172V00000X	Community Health Worker
3	347C00000X	Private Vehicle
4	372600000X	Adult Companion
5	133N00000X	Nutritionist
6	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1073489282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANISSA NICOLE PAYNE

Provider Business Mailing Address
First Line	:	618 DIJON DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-3321
Country	:	US
Telephone Number	:	713-530-5266
Fax Number	:

Provider Business Practice Location Address
First Line	:	6420 RICHMOND AVE STE 665
Second Line	:	STE# 665
City	:	HOUSTON
State	:	TX
Zip	:	77057-5929
Country	:	US
Telephone Number	:	713-530-5266
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2025
Last Update Date	:	01/24/2026

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