Provider Demographics
NPI:1942019724
Name:PAYNE, RAYNI NICOLE (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:RAYNI
Middle Name:NICOLE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E BROADWAY STE 240
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8022
Mailing Address - Country:US
Mailing Address - Phone:573-815-8145
Mailing Address - Fax:573-815-3832
Practice Address - Street 1:1601 E BROADWAY STE 240
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8022
Practice Address - Country:US
Practice Address - Phone:573-815-8145
Practice Address - Fax:573-815-3832
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019003025363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty