MEDICARE: MR. WILLIAM JASON PAYNE APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	24256	TN

General Provider Information

NPI Number	:	1760989073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM JASON PAYNE APRN

Provider Business Mailing Address
First Line	:	1060 BROADWAY
Second Line	:	#3032
City	:	ALBANY
State	:	NY
Zip	:	12204
Country	:	US
Telephone Number	:	518-400-2715
Fax Number	:	518-519-3331

Provider Business Practice Location Address
First Line	:	1060 BROADWAY
Second Line	:	#3032
City	:	ALBANY
State	:	NY
Zip	:	12204
Country	:	US
Telephone Number	:	518-400-2715
Fax Number	:	518-519-3331

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

Provider Enumeration Date	:	04/12/2018
Last Update Date	:	05/14/2022

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