Provider Demographics
NPI:1306088927
Name:LANE, KARYN REBECCA (ARNP)
Entity type:Individual
Prefix:
First Name:KARYN
Middle Name:REBECCA
Last Name:LANE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:WRIGHT CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74766-0650
Mailing Address - Country:US
Mailing Address - Phone:580-981-2104
Mailing Address - Fax:580-981-2105
Practice Address - Street 1:GENERAL DELIVERY
Practice Address - Street 2:
Practice Address - City:WRIGHT CITY
Practice Address - State:OK
Practice Address - Zip Code:74766-9999
Practice Address - Country:US
Practice Address - Phone:580-981-2104
Practice Address - Fax:580-981-2105
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0060099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily