MEDICARE: MRS. AMY LANEY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN194628	GA

General Provider Information

NPI Number	:	1396526281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY LANEY NP

Provider Business Mailing Address
First Line	:	2220 VERNON STREET
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30240
Country	:	US
Telephone Number	:	762-888-1510
Fax Number	:	762-706-0354

Provider Business Practice Location Address
First Line	:	2220 VERNON STREET
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30240
Country	:	US
Telephone Number	:	762-888-1510
Fax Number	:	762-706-0354

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	03/09/2026

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