Provider Demographics
NPI:1487688362
Name:LAMBERT, MELINDA G (FNP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:G
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1210
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-1210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:808 HUNTER
Practice Address - Street 2:SUITE 4
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-2248
Practice Address - Country:US
Practice Address - Phone:573-471-2905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN102029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO429019706Medicaid
818524118Medicare ID - Type Unspecified