Individual
TYLOR SCOTT PAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAA
Contact information
Practice address
1102 W 32ND ST, JOPLIN, MO 64804-3503
(417) 347-1111
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
32698366
WI
367H00000X
Anesthesiologist Assistant
Primary
75000128A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102822179
ANTHEM PTAN
IN
Enumeration date
01/10/2023
Last updated
12/03/2024
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