Lane Tupa
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Jackson, TN
NPI 1245060367 · NPPES record last updated Apr 9, 2025
Key facts
- NPI
- 1245060367
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 700 W Forest Ave FL 5
Jackson, TN 38301-3937 - Phone
- (731) 541-3755
- NPI assigned
- Aug 5, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250723000304 | TN | Order and Referring Only - Family Practice |
8022524446 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| WT University Medical Associates Inc | Current |
Accepting new patients |
Locations
700 W Forest Ave
Fl 5
Jackson, TN 38301
Phone (731) 423-1932
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
700 W Forest Ave FL 5
Jackson, TN 38301-3937
Mailing address
12100 Rainwood Rd Apt 38
Little Rock, AR 72212-3936
Phone (870) 678-3141
Other providers in Jackson, TN
- Jennifer Tucker
- Jennifer Lauren Tucker
- Elva L. Tuggle
- Tulip Hill Recovery of Jackson
- Cherie Tung
- Gloretta Dianna Turner
- John W Turner
- Justin Turner
- Krystal Shavonne Turner
- Robert D Turner
All providers in Jackson, TN · Student in an Organized Health Care Education/Training Program in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.