Provider Demographics
NPI:1124914692
Name:LAMB, JUSTIN J (RN)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:J
Last Name:LAMB
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SOUTH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-4452
Mailing Address - Country:US
Mailing Address - Phone:870-218-3331
Mailing Address - Fax:
Practice Address - Street 1:100 CE BRAWNER RD
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-3804
Practice Address - Country:US
Practice Address - Phone:870-218-3331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR107788163W00000X, 163WC0400X, 163WI0500X, 163WP2201X, 163WW0000X, 171M00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No171M00000XOther Service ProvidersCase Manager/Care Coordinator