Provider Demographics
NPI:1013998038
Name:LAMB, MELISSA RAE (APRN,BC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:RAE
Last Name:LAMB
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 HEDRICK DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-2902
Mailing Address - Country:US
Mailing Address - Phone:423-623-1057
Mailing Address - Fax:423-625-8620
Practice Address - Street 1:229 HEDRICK DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-2902
Practice Address - Country:US
Practice Address - Phone:423-623-1057
Practice Address - Fax:423-625-8620
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN36416063Medicare PIN
TN36416064Medicare PIN
TN36416061Medicare PIN
TNQ56353Medicare UPIN
TN36416062Medicare PIN
TN36416065Medicare PIN