Provider Demographics
NPI:1730820903
Name:PAYTON, TRUDY D
Entity type:Individual
Prefix:
First Name:TRUDY
Middle Name:D
Last Name:PAYTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N CUSTER RD APT 8107
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3526
Mailing Address - Country:US
Mailing Address - Phone:469-888-9013
Mailing Address - Fax:
Practice Address - Street 1:1300 N CUSTER RD APT 8107
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3526
Practice Address - Country:US
Practice Address - Phone:469-888-9013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-04
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNGJ9301347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle