Provider Demographics
NPI:1659896900
Name:LAMBERT, TRACI (APRN)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13425 DEER SPRING DR
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-3001
Mailing Address - Country:US
Mailing Address - Phone:405-256-3261
Mailing Address - Fax:
Practice Address - Street 1:2524 N BROADWAY STE 314
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4172
Practice Address - Country:US
Practice Address - Phone:405-256-3261
Practice Address - Fax:801-806-5401
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0083858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$OtherSOCIAL