Provider Demographics
NPI:1669943148
Name:PAYTON, MELINDA (CRNP)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:PAYTON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:316 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21636-1126
Mailing Address - Country:US
Mailing Address - Phone:410-634-2380
Mailing Address - Fax:833-908-2287
Practice Address - Street 1:316 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:MD
Practice Address - Zip Code:21636-1126
Practice Address - Country:US
Practice Address - Phone:410-634-2380
Practice Address - Fax:833-908-2287
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR186631363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner