Provider Demographics
NPI:1811418569
Name:LANE, EMILY (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:KORNEGAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LD
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-6483
Mailing Address - Fax:682-885-3113
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-885-1202
Practice Address - Fax:682-885-1204
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83361133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered