MEDICARE: PAYTON RACKLEY

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1821892183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAYTON RACKLEY

Provider Business Mailing Address
First Line	:	4645 AVON LN STE 350
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75033-1214
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4645 AVON LN STE 350
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75033-1214
Country	:	US
Telephone Number	:	972-377-0737
Fax Number	:

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

Provider Enumeration Date	:	04/03/2025
Last Update Date	:	04/03/2025

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Directions to “ PAYTON RACKLEY ” Practice Location

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