Individual
MRS. ELIZABETH DIANE PAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
10821 PLANTSIDE DRIVE, SUITE 104, LOUISVILLE, KY 40299
(502) 412-2995
(502) 412-8025
Mailing address
10821 PLANTSIDE DRIVE, SUITE 104, LOUISVILLE, KY 40299
(502) 412-2995
(502) 412-8025
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
3002826
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000240200
ANTHEM PROV NUMBER
KY
05
—
201016000
—
IN
01
—
2444184000
PASSPORT ADVANTAGE
KY
01
—
500028827
PASSPORT PROV NUMBER
KY
01
—
7765491
AETNA PIN
KY
05
—
78028263
—
KY
Enumeration date
05/24/2006
Last updated
05/18/2011
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