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General NPI Number Information
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NPI Number | 1578373650
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Entity Type | Individual
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Provider Name | KATIE ELIZABETH LANE
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Gender | Female
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 305 BEECHWOOD BLVD
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City | MURFREESBORO
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State | NC
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Zip | 27855-1134
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Country | US
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Telephone | 252-398-3323
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Fax |
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Provider Business Mailing Address
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Address Line | 348 RYLAND RD
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City | TYNER
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State | NC
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Zip | 27980-9788
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Country | US
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Telephone | 252-340-2733
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5021459
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License Number State | NC
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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 | 5021459
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License Number State | NC
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