Provider Demographics
NPI:1063544666
Name:LANE, KAREN MALINDA (APRN)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MALINDA
Last Name:LANE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:MALINDA
Other - Last Name:HODGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1167 SPRATLIN PARK DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-6205
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3644
Practice Address - Street 1:401 HOLSTON DR
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-3127
Practice Address - Country:US
Practice Address - Phone:423-639-1104
Practice Address - Fax:423-467-3644
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN153072163WP0808X
TN16398363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health