Healthcare Provider Details

I. General information

NPI: 1114850328
Provider Name (Legal Business Name): KYRA LANE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125A MEDICAL CIR
WINCHESTER VA
22601-3322
US

IV. Provider business mailing address

125A MEDICAL CIR
WINCHESTER VA
22601-3322
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-1828
  • Fax: 540-722-6207
Mailing address:
  • Phone: 540-667-1828
  • Fax: 540-722-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024197081
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: