Provider Demographics
NPI:1366791675
Name:LAMBOTTE, JOEL ALLEN (PA-C)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:ALLEN
Last Name:LAMBOTTE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 N SAINT JAMES PL
Mailing Address - Street 2:
Mailing Address - City:BEL AIRE
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1404
Mailing Address - Country:US
Mailing Address - Phone:316-259-1516
Mailing Address - Fax:
Practice Address - Street 1:4235 N SAINT JAMES PL
Practice Address - Street 2:
Practice Address - City:BEL AIRE
Practice Address - State:KS
Practice Address - Zip Code:67226-1404
Practice Address - Country:US
Practice Address - Phone:316-259-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8414359-1206363A00000X
MDC05249363A00000X
KS1501666363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant