Provider Demographics
NPI:1982155057
Name:LAMBERT, VICKIE (NP)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 ALCORN DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9323
Mailing Address - Country:US
Mailing Address - Phone:662-665-4665
Mailing Address - Fax:662-665-4645
Practice Address - Street 1:611 ALCORN DR STE 200
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9323
Practice Address - Country:US
Practice Address - Phone:662-665-4665
Practice Address - Fax:662-665-4645
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901817363LA2100X
MS904817363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS006927360Medicaid