Provider Demographics
NPI:1790739464
Name:LAMBERT, JENNIFER ANN (C-FNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4498 POTOMAC HIGHLAND TRAIL
Mailing Address - Street 2:
Mailing Address - City:GREEN BANK
Mailing Address - State:WV
Mailing Address - Zip Code:24944
Mailing Address - Country:US
Mailing Address - Phone:304-456-5115
Mailing Address - Fax:304-456-5118
Practice Address - Street 1:4498 POTOMAC HIGHLAND TRAIL
Practice Address - Street 2:
Practice Address - City:GREEN BANK
Practice Address - State:WV
Practice Address - Zip Code:24944
Practice Address - Country:US
Practice Address - Phone:304-456-5115
Practice Address - Fax:304-456-5118
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV54541363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1069735OtherBRICKSTREET INSURANCE
WV001861429OtherMOUNTAIN STATE BLUE CROSS BLUE SHIELD
WV2005010436-22OtherCERT. # FOR NURSES CRED.
WVWV54541OtherHEALTH PLAN
WV1069735OtherBRICKSTREET INSURANCE
WV3810005602Medicaid
WVLANP81961Medicare PIN
WVWV54541OtherHEALTH PLAN