Provider Demographics
NPI:1194896324
Name:LAMPE, MARY KAY (CRNA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KAY
Last Name:LAMPE
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 NOLL DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-3649
Mailing Address - Country:US
Mailing Address - Phone:660-385-4383
Mailing Address - Fax:
Practice Address - Street 1:405 NOLL DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-3649
Practice Address - Country:US
Practice Address - Phone:660-385-4383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO054785367500000X
IAD040798367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX890564OtherBLUE CROSS BLUE SHIELD
TXP00637027OtherMEDICARE RAILROAD
TX195548601Medicaid
TX8K89337Medicare PIN