Provider Demographics
NPI:1568945673
Name:LANE, KIMBERLY ANN
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:BAIRD
Mailing Address - State:TX
Mailing Address - Zip Code:79504-4017
Mailing Address - Country:US
Mailing Address - Phone:325-514-7759
Mailing Address - Fax:
Practice Address - Street 1:737 CHERRY ST
Practice Address - Street 2:
Practice Address - City:BAIRD
Practice Address - State:TX
Practice Address - Zip Code:79504-4017
Practice Address - Country:US
Practice Address - Phone:325-514-7759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX554926163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse