Provider Demographics
NPI:1821467473
Name:LAMBERT, MACKENZIE RAEN (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:RAEN
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:MAKENZIE
Other - Middle Name:RAEN
Other - Last Name:DEGRAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 936952
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6952
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5875 BREMO RD STE 500
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1928
Practice Address - Country:US
Practice Address - Phone:804-297-3055
Practice Address - Fax:804-297-3056
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172965363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics