Provider Demographics
NPI:1245252725
Name:LANE, KERRY H (NP)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:H
Last Name:LANE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MAHONEY AVE
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4837
Mailing Address - Country:US
Mailing Address - Phone:802-773-3553
Mailing Address - Fax:802-773-3845
Practice Address - Street 1:3 MAHONEY AVE
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4837
Practice Address - Country:US
Practice Address - Phone:802-773-3553
Practice Address - Fax:802-773-3845
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0012379363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0NP3756Medicaid
369303OtherMVP
VT58658OtherBCBS
369303OtherMVP
VTNP375604Medicare PIN