Healthcare Provider Details

I. General information

NPI: 1235970328
Provider Name (Legal Business Name): KAITLYN MARIE LAMBERT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST CLAVERICK 2
PROVIDENCE RI
02903
US

IV. Provider business mailing address

15 LASALLE SQUARE
PROVIDENCE RI
02903
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-4000
  • Fax:
Mailing address:
  • Phone: 401-444-6779
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01939
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: