Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | ARNP9309528 | FL |
NPI | 1598139859 |
---|---|
Provider Name | Mr. Kyle Adam Payne |
First Address | Lakeland, FL 33813-4429 |
Second Address | Lakeland, FL 33813-4429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2015 |
Last Update Date | 08/10/2020 |