Provider Demographics
NPI:1609492230
Name:LANE, KIANNA JEANETTE
Entity type:Individual
Prefix:MRS
First Name:KIANNA
Middle Name:JEANETTE
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15239 CHRISTY CV
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-2806
Mailing Address - Country:US
Mailing Address - Phone:201-362-5958
Mailing Address - Fax:
Practice Address - Street 1:15239 CHRISTY CV
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2806
Practice Address - Country:US
Practice Address - Phone:201-362-5958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula