Individual
JESSICA PAYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
312 W MONTANA AVE, BONIFAY, FL 32425-1625
(850) 849-6373
Mailing address
312 W MONTANA AVE, BONIFAY, FL 32425-1625
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5204256
FL
Other
Enumeration date
03/03/2017
Last updated
03/03/2017
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