Healthcare Provider Details

I. General information

NPI: 1245165190
Provider Name (Legal Business Name): LANE DAKOTA SEARS APRN PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 LOUDEN RD
WILLIAMSBURG KY
40769-7265
US

IV. Provider business mailing address

836 LOUDEN RD
WILLIAMSBURG KY
40769-7265
US

V. Phone/Fax

Practice location:
  • Phone: 606-261-5169
  • Fax:
Mailing address:
  • Phone: 606-261-5169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4058357
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: