Provider Demographics
NPI:1245732874
Name:LANE, CRYSTAL DAWN (MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DAWN
Last Name:LANE
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 MINERAL ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-3827
Mailing Address - Country:US
Mailing Address - Phone:423-226-5431
Mailing Address - Fax:423-205-4861
Practice Address - Street 1:223 MINERAL ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-3827
Practice Address - Country:US
Practice Address - Phone:423-226-5431
Practice Address - Fax:423-205-4861
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23939363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health