Healthcare Provider Details

I. General information

NPI: 1104958560
Provider Name (Legal Business Name): JANICE HALLFORD LAMPE PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANICE HALLFORD WILKS PHYSICIAN ASSISTANT

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 SLIDE RD # D24
LUBBOCK TX
79414-4310
US

IV. Provider business mailing address

5219 CITY BANK PKWY STE 35
LUBBOCK TX
79407-3545
US

V. Phone/Fax

Practice location:
  • Phone: 806-761-0450
  • Fax: 806-796-7259
Mailing address:
  • Phone: 806-761-0333
  • Fax: 806-782-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13264
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA03109
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: