Provider Demographics
NPI:1528171758
Name:LAMBERT, PHILLIP NEWTON (FNP)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:NEWTON
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2309
Mailing Address - Country:US
Mailing Address - Phone:662-843-2721
Mailing Address - Fax:662-846-1728
Practice Address - Street 1:803 1ST ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2309
Practice Address - Country:US
Practice Address - Phone:662-843-2721
Practice Address - Fax:662-846-1728
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR850361363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118768Medicaid
S69280Medicare UPIN
MS302I502707Medicare PIN