MEDICARE: NESHOBEY PAYNE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker		MO

General Provider Information

NPI Number	:	1336071422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NESHOBEY PAYNE

Provider Business Mailing Address
First Line	:	12425 OLD HALLS FERRY RD
Second Line	:
City	:	BLACK JACK
State	:	MO
Zip	:	63033-4201
Country	:	US
Telephone Number	:	314-713-2432
Fax Number	:	314-713-2432

Provider Business Practice Location Address
First Line	:	1968 CHAMBERS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-3241
Country	:	US
Telephone Number	:	314-713-2432
Fax Number	:	314-713-2432

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

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “ NESHOBEY PAYNE ” Practice Location

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