Provider Demographics
NPI:1871123331
Name:PAYNE, JULIE ANN (DNP-A, CRNA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:DNP-A, CRNA
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:HUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6025 AVONSHIRE LN APT 420
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-8040
Mailing Address - Country:US
Mailing Address - Phone:661-889-3668
Mailing Address - Fax:
Practice Address - Street 1:609 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3836
Practice Address - Country:US
Practice Address - Phone:940-627-5921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144689367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered