Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | PAY104366803 | TX |
NPI | 1013294495 |
---|---|
Provider Name | Brenna Dawn Payne |
First Address | Amarillo, TX 79124-2154 |
Second Address | Amarillo, TX 79124-2154 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2011 |
Last Update Date | 12/01/2012 |