Healthcare Provider Details

I. General information

NPI: 1487574844
Provider Name (Legal Business Name): LAUREN LANE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 WATSON BLVD
WARNER ROBINS GA
31093-3606
US

IV. Provider business mailing address

160 WILLIAMS CIR
ELKO GA
31025-2032
US

V. Phone/Fax

Practice location:
  • Phone: 478-929-8030
  • Fax:
Mailing address:
  • Phone: 478-361-6491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP274855
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: