Provider Demographics
NPI:1750827036
Name:LAMBERT, ANGELISA (APRN)
Entity Type:Individual
Prefix:
First Name:ANGELISA
Middle Name:
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ANGELISA
Other - Middle Name:
Other - Last Name:STOUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 TURNER LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:SALEM
Mailing Address - State:AR
Mailing Address - Zip Code:72576-5600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12300 OLD HIGHWAY 71 S
Practice Address - Street 2:STE A
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916
Practice Address - Country:US
Practice Address - Phone:479-755-6595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004991363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA004991OtherAR APRN LICENCE