MEDICARE: SAMANTHA PAYNE NP

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	363L00000X	Nurse Practitioner	14275612-4405	UT
2	363LP0200X	Pediatric Nurse Practitioner	0001295568	VA

General Provider Information

NPI Number	:	1811844228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA PAYNE NP

Provider Business Mailing Address
First Line	:	13101 W MISSISSIPPI CT APT 109
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-3470
Country	:	US
Telephone Number	:	336-406-5180
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N MARIO CAPECCHI DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84113-1103
Country	:	US
Telephone Number	:	336-406-5180
Fax Number	:

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

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	04/07/2026

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