Provider Demographics
NPI:1962439737
Name:LANE, KELLY A (ARNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:LANE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:147 PARLIAMENT LOOP STE 1005
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3560
Mailing Address - Country:US
Mailing Address - Phone:407-688-9446
Mailing Address - Fax:407-688-9448
Practice Address - Street 1:147 PARLIAMENT LOOP STE 1005
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3560
Practice Address - Country:US
Practice Address - Phone:407-688-9446
Practice Address - Fax:407-688-9448
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-005706363L00000X
FLARNP9315463363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILS84883Medicare UPIN