Healthcare Provider Details

I. General information

NPI: 1548331101
Provider Name (Legal Business Name): GREGORY KEITH LAMBERT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SOUTHCREST CIR SUITE 200
SOUTHAVEN MS
38671-6726
US

IV. Provider business mailing address

1985 HIGBEE AVE
MEMPHIS TN
38104-5218
US

V. Phone/Fax

Practice location:
  • Phone: 662-349-2588
  • Fax: 662-349-2577
Mailing address:
  • Phone: 901-722-4199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberA810173
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: