Provider Demographics
NPI:1730064551
Name:PAYNE, TRACIE LYNN (RN)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:LYNN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TRACIE
Other - Middle Name:LYNN
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:165 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:KALAMA
Mailing Address - State:WA
Mailing Address - Zip Code:98625-9698
Mailing Address - Country:US
Mailing Address - Phone:360-931-4107
Mailing Address - Fax:
Practice Address - Street 1:165 PORTER RD
Practice Address - Street 2:
Practice Address - City:KALAMA
Practice Address - State:WA
Practice Address - Zip Code:98625-9698
Practice Address - Country:US
Practice Address - Phone:360-931-4107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00171735163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse