Provider Demographics
NPI:1750576518
Name:LANE, PENNY CAROL (DNP, FNP, CNM)
Entity type:Individual
Prefix:DR
First Name:PENNY
Middle Name:CAROL
Last Name:LANE
Suffix:
Gender:F
Credentials:DNP, FNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23556 LANSDOWNE DR. #23556
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40523
Mailing Address - Country:US
Mailing Address - Phone:765-335-2171
Mailing Address - Fax:765-807-3163
Practice Address - Street 1:23556 LANSDOWNE DR. #23556
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40523
Practice Address - Country:US
Practice Address - Phone:765-335-2171
Practice Address - Fax:765-807-3163
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4004532363LF0000X
IN28137047A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily