Provider Demographics
NPI:1477077360
Name:LANE, YARVARIOUS TARVETT (APNP, PMHNP-BC, FNP)
Entity type:Individual
Prefix:
First Name:YARVARIOUS
Middle Name:TARVETT
Last Name:LANE
Suffix:
Gender:F
Credentials:APNP, PMHNP-BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 3 RD AVE ALBANY
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31705-3734
Mailing Address - Country:US
Mailing Address - Phone:229-312-1000
Mailing Address - Fax:
Practice Address - Street 1:1200 BROOKSTONE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-2988
Practice Address - Country:US
Practice Address - Phone:706-653-2889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN196763363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily