Healthcare Provider Details

I. General information

NPI: 1144970138
Provider Name (Legal Business Name): LANE LOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16990 W 86TH ST STE 100
LENEXA KS
66219-4506
US

IV. Provider business mailing address

16990 W 86TH ST STE 100
LENEXA KS
66219-4506
US

V. Phone/Fax

Practice location:
  • Phone: 913-676-8400
  • Fax: 913-599-1692
Mailing address:
  • Phone: 913-676-8400
  • Fax: 913-599-1692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05-51791
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: