MEDICARE: LAUREL 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	2084P0804X	Child & Adolescent Psychiatry Physician	007908	AZ
2	2084P0800X	Psychiatry Physician	007908	AZ

General Provider Information

NPI Number	:	1568875193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREL PAYNE

Provider Business Mailing Address
First Line	:	839 W CONGRESS ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-2819
Country	:	US
Telephone Number	:	520-670-3909
Fax Number	:	520-309-2560

Provider Business Practice Location Address
First Line	:	4888 N STONE AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-5749
Country	:	US
Telephone Number	:	520-670-3909
Fax Number	:	520-309-2560

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

Provider Enumeration Date	:	06/11/2014
Last Update Date	:	05/30/2026

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4888 N STONE AVE
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1174469589 — WILLIAM GARDNER BARKER LAC
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Directions to “ LAUREL PAYNE ” Practice Location

Language	Start Address	Practice Location

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