Provider Demographics
NPI:1144029588
Name:PAYTON, KENNETH
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:PAYTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 COUNTY ROAD 182A
Mailing Address - Street 2:
Mailing Address - City:BAY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39422-9694
Mailing Address - Country:US
Mailing Address - Phone:601-433-9806
Mailing Address - Fax:334-690-1212
Practice Address - Street 1:245 COUNTY ROAD 182A
Practice Address - Street 2:
Practice Address - City:BAY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39422-9694
Practice Address - Country:US
Practice Address - Phone:601-433-9806
Practice Address - Fax:334-690-1212
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty