Provider Demographics
NPI:1699494997
Name:LANE, AMANDA ELLEN (APRN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ELLEN
Last Name:LANE
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3912 LAKE VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-5197
Mailing Address - Country:US
Mailing Address - Phone:423-956-4419
Mailing Address - Fax:
Practice Address - Street 1:10805 HARDING DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-3240
Practice Address - Country:US
Practice Address - Phone:865-675-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000030769363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily