Provider Demographics
NPI:1699376889
Name:LANEY, KATHERINE ALLISON (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ALLISON
Last Name:LANEY
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:GILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75645-6807
Mailing Address - Country:US
Mailing Address - Phone:903-790-8615
Mailing Address - Fax:
Practice Address - Street 1:739 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75645-6807
Practice Address - Country:US
Practice Address - Phone:903-790-8615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX830788163W00000X
TX1135575363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse