Provider Demographics
NPI:1740395466
Name:LANE, THOMAS JASON (FNP-BC, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JASON
Last Name:LANE
Suffix:
Gender:M
Credentials:FNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 WESTCHASE BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-3978
Mailing Address - Country:US
Mailing Address - Phone:919-828-9937
Mailing Address - Fax:919-828-4287
Practice Address - Street 1:4011 WESTCHASE BLVD STE 225
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-3978
Practice Address - Country:US
Practice Address - Phone:919-828-9937
Practice Address - Fax:919-828-4287
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC005002027363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7006352Medicaid