| Lifesource Of North Carolina | |
|
200 Nursing Home Ln Pikeville KY 41501-6896 | |
| (910) 742-9243 | |
| (888) 746-1787 |
| Full Name | Lifesource Of North Carolina |
|---|---|
| Speciality | Social Worker |
| Location | 200 Nursing Home Ln, Pikeville, Kentucky |
| Authorized Official Name and Position | Peggy Baddour (PRESIDENT) |
| Authorized Official Contact | 9107779165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifesource Of North Carolina Po Box 538622 Atlanta GA 30353-8622 Ph: (910) 535-1211 | Lifesource Of North Carolina 200 Nursing Home Ln Pikeville KY 41501-6896 Ph: (910) 742-9243 |
| NPI Number | 1538728183 |
|---|---|
| Provider Enumeration Date | 06/07/2019 |
| Last Update Date | 03/25/2021 |
| Certification Date | 03/25/2021 |
| Medicare PECOS PAC ID | 7416132428 |
|---|---|
| Medicare Enrollment ID | O20190620002144 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538728183 | NPI | - | NPPES |
| Provider Name | Steven Shelton |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215934310 PECOS PAC ID: 6406754910 Enrollment ID: I20050510000331 |
| Provider Name | Sarah E Parsons |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124041686 PECOS PAC ID: 9739286923 Enrollment ID: I20090723000048 |
| Provider Name | Charlene Cochran |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881960953 PECOS PAC ID: 6406017300 Enrollment ID: I20120420000316 |
| Provider Name | Natashia Little |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760858799 PECOS PAC ID: 9436467834 Enrollment ID: I20151005002824 |
| Provider Name | Willie James Campbell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417217092 PECOS PAC ID: 1456500545 Enrollment ID: I20190626003879 |
| Provider Name | Crystal Coleman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427522028 PECOS PAC ID: 2668709569 Enrollment ID: I20190815001920 |
| Provider Name | Kelley Fulkerson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578942140 PECOS PAC ID: 4385070036 Enrollment ID: I20200129000447 |
| Provider Name | Angela S Ellison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871134999 PECOS PAC ID: 0446684856 Enrollment ID: I20200619001980 |
| Provider Name | Harold Kweku Bedu-addo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922620624 PECOS PAC ID: 6709282924 Enrollment ID: I20210913002743 |
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