Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 14847 | TN |
NPI | 1003139502 |
---|---|
Provider Name | Rachel Payne |
First Address | Knoxville, TN 37919-5876 |
Second Address | Knoxville, TN 37923-4717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2010 |
Last Update Date | 03/05/2016 |