Healthcare Provider Details

I. General information

NPI: 1497088553
Provider Name (Legal Business Name): CAYCI DENISE LANE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 FOUNTAIN VALLEY DR SUITE 150
KNOXVILLE TN
37918-5327
US

IV. Provider business mailing address

4005 FOUNTAIN VALLEY DR SUITE 150
KNOXVILLE TN
37918-5327
US

V. Phone/Fax

Practice location:
  • Phone: 865-223-6561
  • Fax:
Mailing address:
  • Phone: 865-223-6561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN0000015652
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000170691
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: