Provider Demographics
NPI:1902914005
Name:PAYNE, PATRICIA A (ARNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:PAYNE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12303 NE 130TH LN
Mailing Address - Street 2:SUITE #420
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3099
Mailing Address - Country:US
Mailing Address - Phone:425-899-6400
Mailing Address - Fax:425-899-4490
Practice Address - Street 1:12303 NE 130TH LN
Practice Address - Street 2:SUITE #420
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3099
Practice Address - Country:US
Practice Address - Phone:425-899-6400
Practice Address - Fax:425-899-4490
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9623011Medicaid
WAS51963Medicare UPIN
WA9623011Medicaid