Provider Demographics
NPI:1821763608
Name:LANIER, KAYLEN ANNE
Entity Type:Individual
Prefix:
First Name:KAYLEN
Middle Name:ANNE
Last Name:LANIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLEN
Other - Middle Name:ANNE
Other - Last Name:GURWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3723 E 39TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2411
Mailing Address - Country:US
Mailing Address - Phone:913-563-9454
Mailing Address - Fax:
Practice Address - Street 1:3723 E 39TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2411
Practice Address - Country:US
Practice Address - Phone:913-563-9454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program