Provider Demographics
NPI:1841551298
Name:LAMBOURN, BRIDGETTE PAYNE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:BRIDGETTE
Middle Name:PAYNE
Last Name:LAMBOURN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BRIDGETTE
Other - Middle Name:ELIZABETH
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 22926
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-2926
Mailing Address - Country:US
Mailing Address - Phone:713-559-6929
Mailing Address - Fax:713-400-2993
Practice Address - Street 1:1635 NORTH LOOP WEST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1593
Practice Address - Country:US
Practice Address - Phone:713-400-2990
Practice Address - Fax:713-400-2993
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRN725622163W00000X
TXAP121959363L00000X
TX88252367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX309519202Medicaid