Provider Demographics
NPI:1063845345
Name:LAMBERT, THERESA LEIGH (APRN)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:LEIGH
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:L
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:2109 MONTICELLO CT
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-5021
Mailing Address - Country:US
Mailing Address - Phone:281-684-5953
Mailing Address - Fax:
Practice Address - Street 1:2109 MONTICELLO CT
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-5021
Practice Address - Country:US
Practice Address - Phone:254-939-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX535825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0328Medicaid