Provider Demographics
NPI:1568847903
Name:LAMB, KIRSTEN POWELL (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:POWELL
Last Name:LAMB
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9219
Mailing Address - Fax:239-343-9218
Practice Address - Street 1:5225 CLAYTON CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2117
Practice Address - Country:US
Practice Address - Phone:239-343-8250
Practice Address - Fax:239-343-8249
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9497804363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV5933C185OtherMEDICARE
WVPO1558642OtherRAILROAD MEDICARE
FL102401400Medicaid