Healthcare Provider Details

I. General information

NPI: 1467549865
Provider Name (Legal Business Name): JENNIFER L LAMBERT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E 19TH ST
MOUNTAIN GROVE MO
65711-1114
US

IV. Provider business mailing address

1100 N KENTUCKY AVE P.O. BOX 1100
WEST PLAINS MO
65775-2029
US

V. Phone/Fax

Practice location:
  • Phone: 417-926-6563
  • Fax: 417-926-5820
Mailing address:
  • Phone: 417-256-9111
  • Fax: 417-257-5947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT011902
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2010024114
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: