Organization
LANE FAMILY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KARYN REBECCA LANE ARNP (NURSE PRACTITIONER/ SOLE OWNER)
(580) 981-2104
Entity
Organization
Contact information
Practice address
207 W 10TH STREET, WRIGHT CITY, OK 74766
(580) 981-2104
Mailing address
207 W 10TH STREET, P.O. BOX 650, WRIGHT CITY, OK 74766
(580) 981-2104
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
60099
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306088927
NPI INDIVIDUAL
OK
05
—
200248480A
—
OK
Enumeration date
09/30/2010
Last updated
09/30/2010
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