Provider Demographics
NPI:1790547362
Name:LAMBERT, RACHAEL WAGONER (FNP-C)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:WAGONER
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 SGT PRENTISS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4754
Mailing Address - Country:US
Mailing Address - Phone:601-442-1900
Mailing Address - Fax:601-442-1908
Practice Address - Street 1:46 SGT PRENTISS DR STE 101
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4754
Practice Address - Country:US
Practice Address - Phone:601-442-1900
Practice Address - Fax:601-442-1908
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily