Provider Demographics
NPI:1427157338
Name:LANE, STACY (FNP)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 HARTSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-2523
Mailing Address - Country:US
Mailing Address - Phone:615-451-9246
Mailing Address - Fax:615-575-5040
Practice Address - Street 1:262 NEW SHACKLE ISLAND RD
Practice Address - Street 2:SUITE 203
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2489
Practice Address - Country:US
Practice Address - Phone:615-824-1142
Practice Address - Fax:615-264-3635
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007616363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily