Provider Demographics
NPI:1770192957
Name:LAMBERTH, BRANDON (NP-C)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:LAMBERTH
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 S BISHOP AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-4320
Mailing Address - Country:US
Mailing Address - Phone:573-426-4411
Mailing Address - Fax:573-426-4403
Practice Address - Street 1:603 S BISHOP AVE STE C
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-4320
Practice Address - Country:US
Practice Address - Phone:573-426-4411
Practice Address - Fax:573-426-4403
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020014741363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner