Individual
MR. JOHNNY PHILLIP PAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP DNP
Contact information
Practice address
2655 SISKIYOU BLVD, MEDFORD, OR 97504-8125
(541) 304-8008
(541) 612-3557
Mailing address
2655 SISKIYOU BLVD, MEDFORD, OR 97504-8125
(541) 304-8008
(541) 612-3557
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
201250098NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201250098NP
OREGON LICENSE
OR
Enumeration date
06/10/2009
Last updated
03/04/2024
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