Provider Demographics
NPI:1548331101
Name:LAMBERT, GREGORY KEITH (CRNA)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:KEITH
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 HIGBEE AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5218
Mailing Address - Country:US
Mailing Address - Phone:901-722-4199
Mailing Address - Fax:
Practice Address - Street 1:401 SOUTHCREST CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6726
Practice Address - Country:US
Practice Address - Phone:662-349-2588
Practice Address - Fax:662-349-2577
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA810173367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered