Individual
PENNY RAE PAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1532 LONE OAK RD STE 320, PADUCAH, KY 42003-7942
(270) 415-3830
Mailing address
1532 LONE OAK RD STE 320, PADUCAH, KY 42003-7942
(270) 441-4300
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA769
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95006011
—
KY
Enumeration date
09/14/2006
Last updated
09/07/2023
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