Basic Information
| Provider Information | |||||||||
| NPI: | 1174585269 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAYTON | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | CFNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 122 PINNELL ST | ||||||||
| Address2: | |||||||||
| City: | RIPLEY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 252719101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043731578 | ||||||||
| FaxNumber: | 3043722749 | ||||||||
| Practice Location | |||||||||
| Address1: | 122 PINNELL ST | ||||||||
| Address2: | |||||||||
| City: | RIPLEY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 252719101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043731578 | ||||||||
| FaxNumber: | 3043722749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 45147 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 3810004634 | 05 | WV | MEDICAID |