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General NPI Number Information
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NPI Number | 1225679558
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Entity Type | Individual
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Provider Name | CHARITY ANGELA LANE APRN
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Gender | Female
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 104 WEST STATE ST
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City | CARAWAY
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State | AR
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Zip | 72419-8553
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Country | US
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Telephone | 870-956-0200
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Fax | 870-895-2164
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Provider Business Mailing Address
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Address Line | 4196 HIGHWAY 62 412 STE A
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City | HARDY
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State | AR
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Zip | 72542-8002
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Country | US
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Telephone | 870-856-1202
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1054179
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26264
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 121536
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License Number State | AR
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1054179
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License Number State | TX
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