Provider Demographics
NPI:1841927373
Name:LAMPKIN, SANDRA DENISE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:DENISE
Last Name:LAMPKIN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W WOODROW WILSON AVE STE 3572
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-7682
Mailing Address - Country:US
Mailing Address - Phone:769-251-5303
Mailing Address - Fax:769-251-5681
Practice Address - Street 1:350 W WOODROW WILSON AVE STE 3572
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7682
Practice Address - Country:US
Practice Address - Phone:769-251-5303
Practice Address - Fax:769-251-5681
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905459363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health