Kenyetta Lovelee Cooper, LSCWA, LCASA is a medicare enrolled "Social Worker - Clinical" provider in Concord, North Carolina. Her current practice location is
284 Executive Park Dr Ste 100, Concord, North Carolina. You can reach out to her office (for appointments etc.) via phone at
(704) 939-1100.
Kenyetta Lovelee Cooper is licensed to practice in North Carolina (license number P013426) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1124687058.
Healthcare Provider's Profile
| Full Name | Kenyetta Lovelee Cooper |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 284 Executive Park Dr Ste 100, Concord, North Carolina |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1124687058
- Provider Enumeration Date: 06/13/2019
- Last Update Date: 08/30/2019
Medicare PECOS Information:
- PECOS PAC ID: 5991183006
- Enrollment ID: I20220601003109
Medical Identifiers
Medical identifiers for Kenyetta Lovelee Cooper such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1124687058 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YA0400X | Counselor - Addiction (substance Use Disorder) | LCAS-25591 (North Carolina) | Secondary |
| 1041C0700X | Social Worker - Clinical | P013426 (North Carolina) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kenyetta Lovelee Cooper allows following entities to bill medicare on her behalf.
| Entity Name | Daymark Recovery Services Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1558329243
PECOS PAC ID: 0547233975
Enrollment ID: O20040814000213 |
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| Entity Name | Free2bu Therapeutic Services Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1295445716
PECOS PAC ID: 2860862240
Enrollment ID: O20221229000448 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kenyetta Lovelee Cooper is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Kenyetta Lovelee Cooper, LSCWA, LCASA
284 Executive Park Dr Ste 100,
Concord, NC 28025-1833
Ph: (704) 939-1100 | Kenyetta Lovelee Cooper, LSCWA, LCASA
284 Executive Park Dr Ste 100,
Concord, NC 28025-1833
Ph: (704) 939-1100 |
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