Basic Information
Provider Information
NPI: 1598168544
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAMBERSON
FirstName: EMMA
MiddleName: SUZETTE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 300 CARSON ST
Address2:  
City: JONESBORO
State: AR
PostalCode: 724013104
CountryCode: US
TelephoneNumber: 8709321198
FaxNumber: 8709107709
Practice Location
Address1: 300 CARSON ST
Address2:  
City: JONESBORO
State: AR
PostalCode: 724013104
CountryCode: US
TelephoneNumber: 8709321198
FaxNumber: 8709107709
Other Information
ProviderEnumerationDate: 10/06/2014
LastUpdateDate: 12/02/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XA004222ARY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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