Provider Demographics
NPI:1730321621
Name:LANE, KATHERINE ANNE (FNP)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:ANNE
Last Name:LANE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:ANNE
Other - Last Name:GILMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:5514 CORPORATE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-7754
Mailing Address - Country:US
Mailing Address - Phone:816-271-1350
Mailing Address - Fax:816-271-1355
Practice Address - Street 1:5514 CORPORATE DR STE 120
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-7754
Practice Address - Country:US
Practice Address - Phone:816-271-1350
Practice Address - Fax:816-271-1355
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007003411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1730321621Medicaid
MON66000009Medicare Oscar/Certification
MO145C00003Medicare Oscar/Certification
MOF29A00021Medicare Oscar/Certification