Fern Lane Company, LLC
Organization Active NPI Primary Care Clinic/Center · La Conner, WA
NPI 1497255293 · NPPES record last updated Jan 15, 2020
Key facts
- NPI
- 1497255293
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- FERN LANE COMPANY, LLC
- Practice address
- 708 E Morris St
Suite B
La Conner, WA 98257 - Phone
- (360) 630-5141
- Fax
- (866) 302-7491
- NPI assigned
- Feb 19, 2018
- Organization subpart
- No
Authorized official
- Name
- Dr. Brianna Wilson, ARNP
- Title
- Owner
- Phone
- (360) 941-5519
Practitioners 5
-
Nicolette Liukko, ARNP
-
Brianna Jean Wilson, DNP, ARNP
-
Elizabeth Price, NURSE PRACTITIONER
-
Sarah Miller, ARNP, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 50D2146797 | Thrive Direct Health Care | Certificate of waiver | Apr 4, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180907001031 | WA | Part B Supplier - Clinic/Group Practice | 0840540159 |
Receives reassigned benefits from 3 practitioners Practice locations: La Conner, WA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes | ||
| Pain Clinic/Center | 261QP3300X |
Addresses
Primary practice location
708 E Morris St
Suite B
La Conner, WA 98257
Mailing address
PO Box 2104
La Conner, WA 98257-2104
Phone (360) 630-5141
Other names
- Thrive Direct Health Care
Other providers in La Conner, WA
- Anna Rae Degraffenreid
- Denis Gerard Donoghue
- John E Dugaw Jr.
- Susan Jane Erickson
- Amelia Felton
- John K. Fischer
- Alette Ford
- Teodora Louise Rapp Foster
- Jacqueline Franco
- Kelvin R Giles
All providers in La Conner, WA · Primary Care Clinic/Center in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2020. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.