Provider Demographics
NPI:1912893892
Name:LANE, KRYSTINA ELIZABETH (FNP- BC)
Entity type:Individual
Prefix:MRS
First Name:KRYSTINA
Middle Name:ELIZABETH
Last Name:LANE
Suffix:
Gender:F
Credentials:FNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4565 MARKET BELL WAY
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849
Mailing Address - Country:US
Mailing Address - Phone:865-374-3450
Mailing Address - Fax:
Practice Address - Street 1:4565 MARKET BELL WAY
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849
Practice Address - Country:US
Practice Address - Phone:865-374-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38951363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ105690Medicaid