Provider Demographics
NPI:1902108517
Name:PAYNE, WHITNEY (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:WHITESIDE
Other - Last Name:HENDRICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:804 DELHURST DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6734
Mailing Address - Country:US
Mailing Address - Phone:773-339-6642
Mailing Address - Fax:
Practice Address - Street 1:216 S KINGSHIGHWAY BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1026
Practice Address - Country:US
Practice Address - Phone:314-454-8134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010040483363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily