Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 71004088A | IN |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 71004088A | IN |
NPI | 1063771962 |
---|---|
Provider Name | Carla S Payne |
First Address | Indianapolis, IN 46250-2805 |
Second Address | Greenwood, IN 46142-3117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2012 |
Last Update Date | 02/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000779844 | ANTHEM (01) | IN |
000000791892 | ANTHEM (01) | IN |
201085440 | (05) | IN |
9360882 | AETNA (01) | IN |