Provider Demographics
NPI:1053735308
Name:PAYNE, SHARON ANN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ANN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 TEACO RD
Mailing Address - Street 2:STE B
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857
Mailing Address - Country:US
Mailing Address - Phone:573-888-8828
Mailing Address - Fax:573-888-8849
Practice Address - Street 1:501 TEACO RD
Practice Address - Street 2:STE B
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857
Practice Address - Country:US
Practice Address - Phone:573-888-8828
Practice Address - Fax:573-888-8849
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013045364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily