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Kristopher Olen Lane, FNP
Family Nurse Practitioner in Latta, South Carolina
NPI 1306378856

Kristopher Olen Lane is a Family Nurse Practitioner based in Hartsville, SC and is specialized in Family. Kristopher Olen Lane practices in Latta, SC and has the professional credentials of FNP. The NPI Number for Kristopher Olen Lane is 1306378856 and holds a License No. 20909 (South Carolina).

The current practice location address for Kristopher Olen Lane is 122 Latimer St, Latta, SC and can be reached out via phone at 843-627-6252.

Location: 122 Latimer St, Latta, SC, 29551-1090
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1306378856
Provider Name
Kristopher Olen Lane
Credential
FNP
Provider Entity Type
Individual
Gender
Male
Address
122 Latimer St, Latta, SC, 29551-1090
Phone Number
843-627-6252
Fax Number
Provider Enumeration Date
04/03/2017
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
SCA484 01 SC MEDICARE
NP4553 05 SC
institution
Provider Business Practice Location Address Details
Address
122 Latimer St
City
Latta
State
South Carolina
Zip
29565-1828
Phone Number
843-627-6252
Fax Number
person
Provider Business Mailing Address Details
Address
122 Latimer St
City
Latta
State
South Carolina
Zip
29565-1828
Phone Number
843-627-6252
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
363LF0000X
License No.
20909 (South Carolina)
Definition
Definition to come...
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