Provider Demographics
NPI:1700820388
Name:LAMBERTH, ASHLEA B (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEA
Middle Name:B
Last Name:LAMBERTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-1413
Mailing Address - Country:US
Mailing Address - Phone:615-325-6755
Mailing Address - Fax:615-325-6936
Practice Address - Street 1:307 S BROADWAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1413
Practice Address - Country:US
Practice Address - Phone:615-325-6755
Practice Address - Fax:615-325-6936
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6807363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3902957Medicaid
TN3902957Medicare ID - Type Unspecified