Provider Demographics
NPI:1578373650
Name:LANE, KATIE ELIZABETH
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ELIZABETH
Last Name:LANE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 RYLAND RD
Mailing Address - Street 2:
Mailing Address - City:TYNER
Mailing Address - State:NC
Mailing Address - Zip Code:27980-9788
Mailing Address - Country:US
Mailing Address - Phone:252-340-2733
Mailing Address - Fax:
Practice Address - Street 1:305 BEECHWOOD BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:NC
Practice Address - Zip Code:27855-1134
Practice Address - Country:US
Practice Address - Phone:252-398-3323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021459207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine