Active NPI
Amy Raquel Payne
- Pharmacist
- Tulsa, OK
National Provider Identifier
1659652964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12039
- Practice address
- 1440 S Lewis Ave
Tulsa, OK 74104-4624 - Phone
- (918) 747-6429
- Fax
- (918) 747-3715
- NPI assigned
- Aug 31, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 12039 | OK | Primary |
Addresses
Primary practice location
1440 S Lewis Ave
Tulsa, OK 74104-4624
Mailing address
1440 S Lewis Ave
Tulsa, OK 74104-4624
Phone (918) 747-6429
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12039 | Other | OK | STATE BOARD OF PHARMACY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12039 | OK | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314748800000",
"number": "1659652964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1440 S LEWIS AVE",
"city": "TULSA",
"state": "OK",
"postal_code": "741044624",
"telephone_number": "918-747-6429",
"fax_number": "918-747-3715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1440 S LEWIS AVE",
"city": "TULSA",
"state": "OK",
"postal_code": "741044624",
"telephone_number": "918-747-6429",
"fax_number": "918-747-3715"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAYNE",
"first_name": "AMY",
"middle_name": "RAQUEL",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-31",
"last_updated": "2011-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "12039",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE BOARD OF PHARMACY",
"identifier": "12039",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tulsa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.