Provider Demographics
NPI:1326270570
Name:LANE, JENNIFER E (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:LANE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3889
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3889
Mailing Address - Country:US
Mailing Address - Phone:423-794-2457
Mailing Address - Fax:423-283-9480
Practice Address - Street 1:444 CLINCHFIELD ST STE 2700
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3858
Practice Address - Country:US
Practice Address - Phone:423-230-2700
Practice Address - Fax:423-239-7402
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1326270570Medicaid
TNP00799351OtherMEDICARE RR
TN1517266Medicaid
TN103I503163Medicare PIN
TNP00799351OtherMEDICARE RR
TN103I502823Medicare PIN
VA1326270570Medicaid