Active NPI
Keera Quantae Lane
- Social Worker
- Vicksburg, MS
National Provider Identifier
1790342525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 3530 Manor Dr Ste 5
Vicksburg, MS 39180-5625 - Phone
- (601) 738-5260
- NPI assigned
- May 28, 2019
- Last updated
- May 28, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | NU | Primary |
Addresses
Primary practice location
3530 Manor Dr Ste 5
Vicksburg, MS 39180-5625
Mailing address
860 E River PL Ste 100
Jackson, MS 39202-3442
Phone (769) 251-5590
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559001600000",
"number": "1790342525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "860 E RIVER PL STE 100",
"city": "JACKSON",
"state": "MS",
"postal_code": "392023442",
"telephone_number": "769-251-5590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3530 MANOR DR STE 5",
"city": "VICKSBURG",
"state": "MS",
"postal_code": "391805625",
"telephone_number": "601-738-5260"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANE",
"first_name": "KEERA",
"middle_name": "QUANTAE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-28",
"last_updated": "2019-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vicksburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.