# LANE FAMILY CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891004412
- **Authorized official:** MRS. KARYN REBECCA LANE ARNP (NURSE PRACTITIONER/ SOLE OWNER)
- **Authorized official phone:** (580) 981-2104

## Contact information

- **Practice address:** 207 W 10TH STREET, WRIGHT CITY, OK 74766
- **Practice address phone:** (580) 981-2104
- **Mailing address:** 207 W 10TH STREET, P.O. BOX 650, WRIGHT CITY, OK 74766
- **Mailing address phone:** (580) 981-2104

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 60099 | OK | Yes |

## Other

- **Enumeration date:** 09/30/2010
- **Last updated:** 09/30/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1306088927 | NPI INDIVIDUAL | OK |
| 05 | — | 200248480A | — | OK |