Provider Demographics
NPI:1477902906
Name:LAMPKIN, JIMMY JR
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:LAMPKIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6275 BOULDER HWY
Mailing Address - Street 2:APT 2027
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-7462
Mailing Address - Country:US
Mailing Address - Phone:702-237-0070
Mailing Address - Fax:
Practice Address - Street 1:6275 BOULDER HWY
Practice Address - Street 2:APT 2027
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-7462
Practice Address - Country:US
Practice Address - Phone:702-237-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare