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General NPI Number Information
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NPI Number | 1811633845
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Entity Type | Individual
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Provider Name | CRYSTAL DAWN LANE PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/11/2022
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 12811 KENWOOD LN STE 202
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City | FORT MYERS
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State | FL
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Zip | 33907-5646
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Country | US
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Telephone | 239-537-9646
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Fax | 239-236-0866
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Provider Business Mailing Address
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Address Line | 6252 S PHILMAR DR
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City | SPRINGFIELD
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State | MO
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Zip | 65804-7904
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Country | US
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Telephone | 417-350-8236
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11029121
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 220223
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2022017504
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License Number State | MO
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