Provider Demographics
NPI:1437957156
Name:PAYTON, KHADIJAH SMITH (FNP)
Entity type:Individual
Prefix:MRS
First Name:KHADIJAH
Middle Name:SMITH
Last Name:PAYTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SAWGRASS DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-6410
Mailing Address - Country:US
Mailing Address - Phone:985-628-6506
Mailing Address - Fax:
Practice Address - Street 1:40 SAWGRASS DR
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-6410
Practice Address - Country:US
Practice Address - Phone:985-628-6506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAF02250807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily