Provider Demographics
NPI:1134660673
Name:LAMB, TABETHA MARIA (PSS)
Entity Type:Individual
Prefix:
First Name:TABETHA
Middle Name:MARIA
Last Name:LAMB
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1589 HILL RISE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2588
Mailing Address - Country:US
Mailing Address - Phone:859-977-2508
Mailing Address - Fax:
Practice Address - Street 1:1589 HILL RISE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2588
Practice Address - Country:US
Practice Address - Phone:859-977-2508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist