Provider Demographics
NPI:1700965795
Name:LANE, CARRIE SHAYNE (WHCNP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:SHAYNE
Last Name:LANE
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6506 NICHOLAS DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-7119
Mailing Address - Country:US
Mailing Address - Phone:806-372-8731
Mailing Address - Fax:806-372-8746
Practice Address - Street 1:1501 S TAYLOR ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-4307
Practice Address - Country:US
Practice Address - Phone:806-372-8731
Practice Address - Fax:806-372-8746
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX563362363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15389501Medicaid
TXS64194Medicare UPIN