| Lifesource Of North Carolina | |
|
3205 Randall Pkwy Suite 105 Wilmington NC 28403 | |
| (910) 742-9243 | |
| (888) 746-1787 |
| Full Name | Lifesource Of North Carolina |
|---|---|
| Speciality | Internal Medicine |
| Location | 3205 Randall Pkwy, Wilmington, North Carolina |
| Authorized Official Name and Position | Peggy L Baddour (PRESIDENT/OWNER) |
| 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 Lifesource Of North Carolina Atlanta GA 30353-8622 Ph: (910) 742-9243 | Lifesource Of North Carolina 3205 Randall Pkwy Suite 105 Wilmington NC 28403 Ph: (910) 742-9243 |
| NPI Number | 1811286156 |
|---|---|
| Provider Enumeration Date | 04/06/2011 |
| Last Update Date | 12/29/2021 |
| Certification Date | 12/29/2021 |
| Medicare PECOS PAC ID | 7416132428 |
|---|---|
| Medicare Enrollment ID | O20110505000743 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811286156 | NPI | - | NPPES |
| Provider Name | Stephanie Gould Jordan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831172030 PECOS PAC ID: 7113822875 Enrollment ID: I20031204001110 |
| Provider Name | Larry M Gerstenhaber |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922011584 PECOS PAC ID: 7214920362 Enrollment ID: I20040406000152 |
| Provider Name | Vanessa Stanton Butler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205896925 PECOS PAC ID: 6507852225 Enrollment ID: I20040420001513 |
| Provider Name | James William Earnhardt |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1992756019 PECOS PAC ID: 3779569991 Enrollment ID: I20040628001383 |
| Provider Name | Michelle M Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699859751 PECOS PAC ID: 4183601578 Enrollment ID: I20040702000764 |
| Provider Name | Denise W Logan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154693877 PECOS PAC ID: 2365422953 Enrollment ID: I20040723000473 |
| Provider Name | Robert J Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912992777 PECOS PAC ID: 9133194665 Enrollment ID: I20040902000192 |
| Provider Name | Layla Myers Mabe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790774628 PECOS PAC ID: 2567421019 Enrollment ID: I20041008000933 |
| Provider Name | Rhonda Michelle Cartee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730159864 PECOS PAC ID: 7618930553 Enrollment ID: I20041110001235 |
| Provider Name | Arlene G Gallan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1215917455 PECOS PAC ID: 0345291423 Enrollment ID: I20050207000186 |
| Provider Name | Kerry L Balentine |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063518165 PECOS PAC ID: 7618907916 Enrollment ID: I20050816001166 |
| Provider Name | Samantha G Suffren |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356370027 PECOS PAC ID: 1658379425 Enrollment ID: I20061110000327 |
| Provider Name | Sachin S Mody |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730106444 PECOS PAC ID: 7214932482 Enrollment ID: I20070409000492 |
| Provider Name | Emily Katherine Stainback |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922182955 PECOS PAC ID: 3678671583 Enrollment ID: I20070530000593 |
| Provider Name | Suzanne Cline |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598801664 PECOS PAC ID: 0840383824 Enrollment ID: I20070906000820 |
| Provider Name | Marilyn Christine Madden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902923055 PECOS PAC ID: 8325134562 Enrollment ID: I20071018000516 |
| Provider Name | Charles Dunham |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1346268745 PECOS PAC ID: 6002906971 Enrollment ID: I20071214000657 |
| Provider Name | Mary Ellen Lavoie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215967989 PECOS PAC ID: 2567497134 Enrollment ID: I20080114000715 |
| Provider Name | Karen Stukes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831376433 PECOS PAC ID: 0244314524 Enrollment ID: I20080226000122 |
| Provider Name | Michael R Penland |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366611089 PECOS PAC ID: 5496781825 Enrollment ID: I20080521000710 |
| Provider Name | Cynthia K Honeycutt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528215407 PECOS PAC ID: 3375602980 Enrollment ID: I20081111000281 |
| Provider Name | James C Pryor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952320558 PECOS PAC ID: 4183786585 Enrollment ID: I20081218000525 |
| Provider Name | Edith M Gettes |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932327772 PECOS PAC ID: 2567525215 Enrollment ID: I20090107000350 |
| Provider Name | Janet L Poindexter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578564803 PECOS PAC ID: 7618967282 Enrollment ID: I20090117000112 |
| Provider Name | Marion K Hart |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417919697 PECOS PAC ID: 5799830675 Enrollment ID: I20090827000805 |
| Provider Name | Tracy Elizabeth Fee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669567442 PECOS PAC ID: 0244385441 Enrollment ID: I20090910000546 |
| Provider Name | Jennifer L Winkler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902098627 PECOS PAC ID: 0648469668 Enrollment ID: I20110106000549 |
| Provider Name | Stephen Elliott |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417009937 PECOS PAC ID: 1658551577 Enrollment ID: I20110210000285 |
| Provider Name | Alisa Valente |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1902184484 PECOS PAC ID: 1355511379 Enrollment ID: I20110831000355 |
| Provider Name | Monica B Massey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720256928 PECOS PAC ID: 8022289123 Enrollment ID: I20110921000677 |
| Provider Name | Stevan M Clifton |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1730335449 PECOS PAC ID: 4587837273 Enrollment ID: I20111025000164 |
| Provider Name | Ronny E Wright |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1730171109 PECOS PAC ID: 4880868488 Enrollment ID: I20111116000774 |
| Provider Name | Helen Vickers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457439036 PECOS PAC ID: 0840458469 Enrollment ID: I20120228000296 |
| Provider Name | Lashanda Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154616332 PECOS PAC ID: 1254596877 Enrollment ID: I20120705000691 |
| Provider Name | Lois H Reed |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1245549021 PECOS PAC ID: 5294991147 Enrollment ID: I20120723000442 |
| Provider Name | Benedetto Palombo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255691150 PECOS PAC ID: 5294981171 Enrollment ID: I20120808000588 |
| Provider Name | Valerie Chess |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255493847 PECOS PAC ID: 4183715907 Enrollment ID: I20120907000352 |
| Provider Name | Charles D Cook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407288459 PECOS PAC ID: 9032344353 Enrollment ID: I20131022001990 |
| Provider Name | Regina Mozingo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255669529 PECOS PAC ID: 4981832508 Enrollment ID: I20140106000314 |
| Provider Name | Nancy A Dartnall |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1346452901 PECOS PAC ID: 6507094166 Enrollment ID: I20140107000005 |
| Provider Name | Linda Cappiello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174633457 PECOS PAC ID: 6901815836 Enrollment ID: I20140225002062 |
| Provider Name | Suzanne M Gattuso |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639590144 PECOS PAC ID: 2860624467 Enrollment ID: I20140414001589 |
| Provider Name | Maria S Priest |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508990383 PECOS PAC ID: 5991938359 Enrollment ID: I20140509000676 |
| Provider Name | Amy H Rudd |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306184106 PECOS PAC ID: 7517180219 Enrollment ID: I20140528000612 |
| Provider Name | Lori M Tirado |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396159117 PECOS PAC ID: 2365663960 Enrollment ID: I20141023002695 |
| Provider Name | Maggie Whitt Mazurek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376968487 PECOS PAC ID: 2466675822 Enrollment ID: I20150127000563 |
| Provider Name | Crystal Prince Ostheim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821490434 PECOS PAC ID: 5890019699 Enrollment ID: I20150127002361 |
| Provider Name | Jatel Shukla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467854224 PECOS PAC ID: 6204154628 Enrollment ID: I20150415002118 |
| Provider Name | Tracy Lynn Foland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316906431 PECOS PAC ID: 8224064191 Enrollment ID: I20150930001328 |
| Provider Name | Rebecca Blake |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407292915 PECOS PAC ID: 0345540357 Enrollment ID: I20151124000668 |
| Provider Name | Michael J Dewulf |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912248790 PECOS PAC ID: 4688974306 Enrollment ID: I20151202002681 |
| Provider Name | Andrea B Hunt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1023301959 PECOS PAC ID: 9830493824 Enrollment ID: I20160211002275 |
| Provider Name | Michael Besio |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1568796886 PECOS PAC ID: 2567601891 Enrollment ID: I20160301001731 |
| Provider Name | Imani N Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073938254 PECOS PAC ID: 9234437716 Enrollment ID: I20160418000331 |
| Provider Name | Teah Ns Doles-johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982062758 PECOS PAC ID: 6507165503 Enrollment ID: I20160426000651 |
| Provider Name | Hollianne M Ibarra |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639418205 PECOS PAC ID: 6002107281 Enrollment ID: I20160617001195 |
| Provider Name | Ashlie Susanne Morrissey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710339270 PECOS PAC ID: 9133414212 Enrollment ID: I20160829001542 |
| Provider Name | Mary B Lee |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508216516 PECOS PAC ID: 0840586111 Enrollment ID: I20160913001037 |
| Provider Name | Kimberly Rose |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598912784 PECOS PAC ID: 8224326442 Enrollment ID: I20161004000962 |
| Provider Name | Heather Mcfarland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508258583 PECOS PAC ID: 2668773243 Enrollment ID: I20161011000929 |
| Provider Name | Dorothy Nivens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003261074 PECOS PAC ID: 8820381890 Enrollment ID: I20161108000804 |
| Provider Name | Angela F Conder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811370877 PECOS PAC ID: 3476861618 Enrollment ID: I20170109001496 |
| Provider Name | Tara Noelle Mitchell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306178462 PECOS PAC ID: 9032494992 Enrollment ID: I20170316001465 |
| Provider Name | Tremika R Woodley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699217208 PECOS PAC ID: 6507141876 Enrollment ID: I20170329000703 |
| Provider Name | Eileen C Finnegan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063674034 PECOS PAC ID: 6305853458 Enrollment ID: I20170607001743 |
| Provider Name | Eleanor Carroll |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972656999 PECOS PAC ID: 8921378522 Enrollment ID: I20170713003378 |
| Provider Name | Maxine Joy Weisman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124071485 PECOS PAC ID: 7719086990 Enrollment ID: I20170823000212 |
| Provider Name | Katrina Sidney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306372487 PECOS PAC ID: 1355614272 Enrollment ID: I20170829000373 |
| Provider Name | Gretchen Rhea Horner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962667691 PECOS PAC ID: 3577622521 Enrollment ID: I20171005003834 |
| Provider Name | Megan Katherine Blankenship |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366969834 PECOS PAC ID: 4880960970 Enrollment ID: I20171017002159 |
| Provider Name | Mimi E Crawley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639601594 PECOS PAC ID: 9234409152 Enrollment ID: I20171114000209 |
| Provider Name | Rachelle Evans Burrell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780194514 PECOS PAC ID: 8921365917 Enrollment ID: I20171129002004 |
| Provider Name | Bryce Yates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487184446 PECOS PAC ID: 4688931298 Enrollment ID: I20171206000748 |
| Provider Name | George Gail Neffinger |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538187919 PECOS PAC ID: 7113285651 Enrollment ID: I20171211001673 |
| Provider Name | Wesley Kirby Smith |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1619474202 PECOS PAC ID: 7214292499 Enrollment ID: I20180518000749 |
| Provider Name | Virginia Woolfson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336653948 PECOS PAC ID: 6901161827 Enrollment ID: I20180524001577 |
| Provider Name | Virginia Lyon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033455365 PECOS PAC ID: 3072755222 Enrollment ID: I20180820002241 |
| Provider Name | Meghan Kelly Plant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518391986 PECOS PAC ID: 1254680226 Enrollment ID: I20180823003692 |
| Provider Name | Sarah Larson Baker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205226685 PECOS PAC ID: 5193076370 Enrollment ID: I20180927000953 |
| Provider Name | Charmaine Jocelyn Singleton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710356555 PECOS PAC ID: 1254649759 Enrollment ID: I20181003002260 |
| Provider Name | Erica Rochelle Alford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093238768 PECOS PAC ID: 4284986035 Enrollment ID: I20181007000007 |
| Provider Name | Jennifer Lauren Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740762947 PECOS PAC ID: 0547513574 Enrollment ID: I20181022001455 |
| Provider Name | Raul Rodriguez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841554912 PECOS PAC ID: 2567715162 Enrollment ID: I20181029002725 |
| Provider Name | Anna Resnick |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043309230 PECOS PAC ID: 1052590585 Enrollment ID: I20181106000497 |
| Provider Name | Julia Marie Cibula |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649458787 PECOS PAC ID: 2466421706 Enrollment ID: I20181120000072 |
| Provider Name | Thelma Sephes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730132572 PECOS PAC ID: 3173551488 Enrollment ID: I20181130001923 |
| Provider Name | Felicia Harrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497130306 PECOS PAC ID: 6002125101 Enrollment ID: I20181228000547 |
| Provider Name | Andrea Unzelmann Putnam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376011403 PECOS PAC ID: 1355687708 Enrollment ID: I20190107002266 |
| Provider Name | Quintina B Petty |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851862734 PECOS PAC ID: 1951649896 Enrollment ID: I20190219000947 |
| Provider Name | Carla Jane Andersson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093279416 PECOS PAC ID: 5496827149 Enrollment ID: I20190312000482 |
| Provider Name | John Burns |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881900447 PECOS PAC ID: 0143560920 Enrollment ID: I20190313001972 |
| Provider Name | Stefanie M Lawson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730635475 PECOS PAC ID: 4082954243 Enrollment ID: I20190326000660 |
| Provider Name | Tanya F Bush |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619343803 PECOS PAC ID: 1052629151 Enrollment ID: I20190326000831 |
| Provider Name | Pushpinder K Gill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386180230 PECOS PAC ID: 3971843004 Enrollment ID: I20190327001081 |
| Provider Name | Salema Coaxum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487021911 PECOS PAC ID: 4082956537 Enrollment ID: I20190502000454 |
| Provider Name | Dagmar Vodrazkova |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841693132 PECOS PAC ID: 7113256272 Enrollment ID: I20190916000697 |
| Provider Name | Andrea Denise Symes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467989368 PECOS PAC ID: 2668703612 Enrollment ID: I20191007001119 |
| Provider Name | Brandon Ray Chuman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487001434 PECOS PAC ID: 3577850049 Enrollment ID: I20191014003130 |
| Provider Name | Megan D Long |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952950859 PECOS PAC ID: 0941633382 Enrollment ID: I20191126000062 |
| Provider Name | Carmen Mcgill Messer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528602786 PECOS PAC ID: 0345674016 Enrollment ID: I20200106001773 |
| Provider Name | Alonda Jeanette Callender |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437277662 PECOS PAC ID: 1658705330 Enrollment ID: I20200106002093 |
| Provider Name | Todd Leroy Morton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912933086 PECOS PAC ID: 8325931439 Enrollment ID: I20200203002596 |
| Provider Name | Jason Darden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295372324 PECOS PAC ID: 3678900404 Enrollment ID: I20200217004078 |
| Provider Name | Stacy Denise Bradley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437274776 PECOS PAC ID: 7416378369 Enrollment ID: I20200601000899 |
| Provider Name | Willie James Campbell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417217092 PECOS PAC ID: 1456500545 Enrollment ID: I20200622000340 |
| Provider Name | Tesheika N Boomer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598392375 PECOS PAC ID: 9638597172 Enrollment ID: I20200915001694 |
| Provider Name | Elizabeth Fitzgerald |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508142266 PECOS PAC ID: 2062822331 Enrollment ID: I20201028001213 |
| Provider Name | Dara Bushman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063787638 PECOS PAC ID: 0446675482 Enrollment ID: I20201120001297 |
| Provider Name | Brittney Elease Parsons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306442363 PECOS PAC ID: 1052723400 Enrollment ID: I20201209001625 |
| Provider Name | Brandy Hunter Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902405095 PECOS PAC ID: 7416369764 Enrollment ID: I20201210002175 |
| Provider Name | Molly Salmonsen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356943799 PECOS PAC ID: 1254745367 Enrollment ID: I20210202000807 |
| Provider Name | Danielle Karen Segar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700486651 PECOS PAC ID: 9739599473 Enrollment ID: I20210203000165 |
| Provider Name | Nacole H Wood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356932974 PECOS PAC ID: 8729495130 Enrollment ID: I20210401000379 |
| Provider Name | Angela Marie Rasheed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144840943 PECOS PAC ID: 5698180651 Enrollment ID: I20210601001099 |
| Provider Name | Helene Eklen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639572613 PECOS PAC ID: 5597160473 Enrollment ID: I20210817000502 |
| Provider Name | Carl Hurd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346914256 PECOS PAC ID: 3375954084 Enrollment ID: I20210909002088 |
| Provider Name | Ernestine Renea Watson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588123269 PECOS PAC ID: 4981002227 Enrollment ID: I20211018001094 |
| Provider Name | Jana Erika Cua |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225491087 PECOS PAC ID: 6608160635 Enrollment ID: I20211215000372 |
| Provider Name | Ishan Bhansaly |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1972824357 PECOS PAC ID: 6507004157 Enrollment ID: I20220203001128 |
| Provider Name | Andrea Thomas Knight |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588234603 PECOS PAC ID: 5799179503 Enrollment ID: I20220221001846 |
| Provider Name | Lisa Rasheed |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538371687 PECOS PAC ID: 7911276464 Enrollment ID: I20220223000813 |
| Provider Name | Kieshanda Monet Morgan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811667991 PECOS PAC ID: 2062807332 Enrollment ID: I20220323001969 |
| Provider Name | John Kevin Painter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598400350 PECOS PAC ID: 6507243961 Enrollment ID: I20220524003149 |
| Provider Name | Tabitha Bowman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780252767 PECOS PAC ID: 1759762255 Enrollment ID: I20220714002953 |
| Provider Name | Demetris Natasha Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023406774 PECOS PAC ID: 9234456724 Enrollment ID: I20220720003555 |
| Provider Name | Theresa Rose Hypse |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346747540 PECOS PAC ID: 7113308933 Enrollment ID: I20220725002489 |
| Provider Name | Nakeenya Janee Dutton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669847562 PECOS PAC ID: 4688056336 Enrollment ID: I20220728000429 |
| Provider Name | Melanie Lepine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710384797 PECOS PAC ID: 9638590326 Enrollment ID: I20220823001315 |
| Provider Name | Erin Tansey |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417213083 PECOS PAC ID: 2264727486 Enrollment ID: I20221025002298 |
| Provider Name | Joann Benn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689797888 PECOS PAC ID: 2961581335 Enrollment ID: I20221121001185 |
| Provider Name | Perry Stanley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740374438 PECOS PAC ID: 0840391819 Enrollment ID: I20221208001593 |
| Provider Name | Lesley Santangelo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689382038 PECOS PAC ID: 4486631652 Enrollment ID: I20221223001092 |
| Provider Name | Thomas Hall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538416086 PECOS PAC ID: 3072911460 Enrollment ID: I20230110002650 |
| Provider Name | Diana Marmolejos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467094821 PECOS PAC ID: 6204260979 Enrollment ID: I20230112001229 |
| Provider Name | Afi Nono Kpakossou |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497463137 PECOS PAC ID: 7618382193 Enrollment ID: I20230119000494 |
| Provider Name | Patricia Kpan Yates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104018969 PECOS PAC ID: 0648641936 Enrollment ID: I20230124003168 |
| Provider Name | Marianne Yarnall |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1275245789 PECOS PAC ID: 7517338601 Enrollment ID: I20230127002817 |
| Provider Name | Cherise Dailey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396445854 PECOS PAC ID: 6901271519 Enrollment ID: I20230413001496 |
| Provider Name | Greta Rose Martin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164936449 PECOS PAC ID: 0749645679 Enrollment ID: I20230428001617 |
| Provider Name | Alison Stroh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588277727 PECOS PAC ID: 7618332354 Enrollment ID: I20230502000654 |
| Provider Name | Sarah M Grey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467861369 PECOS PAC ID: 5698134989 Enrollment ID: I20230705001604 |
| Provider Name | Zachary Blaine Stroud |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548427370 PECOS PAC ID: 9739373432 Enrollment ID: I20230809000331 |
| Provider Name | Olympic Nicole Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518267723 PECOS PAC ID: 3173985207 Enrollment ID: I20230821003936 |
| Provider Name | Kari A Spencer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457929903 PECOS PAC ID: 3779946124 Enrollment ID: I20230831004196 |
| Provider Name | Megan Wolff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568114650 PECOS PAC ID: 2466831524 Enrollment ID: I20230918002735 |
| Provider Name | Natalie Christine Campbell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689779548 PECOS PAC ID: 3779560008 Enrollment ID: I20231207003168 |
| Provider Name | Isaac Joseph Mcfadden |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316165079 PECOS PAC ID: 3870647506 Enrollment ID: I20231222001872 |
| Provider Name | Umi Aisha Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235906793 PECOS PAC ID: 9830533967 Enrollment ID: I20240216002553 |
| Provider Name | Antoinette K Morris |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770880312 PECOS PAC ID: 7810333580 Enrollment ID: I20240315003641 |
Mqa Support Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 233 Westchester Rd, Wilmington, NC 28409 Phone: 202-658-6337 | |
Coastal Horizons Center, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 615 Shipyard Blvd, Wilmington, NC 28412 Phone: 910-790-0187 Fax: 910-790-0189 | |
Pinnacle Family Services Of North Carolina Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1608 Queen St Ste 3, Wilmington, NC 28401 Phone: 919-790-8580 | |
Crystal River Psychiatric, Grp Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2595 S 17th St, Wilmington, NC 28401 Phone: 910-799-2283 Fax: 910-791-9227 | |
Compass Rose Psychotherapy Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 313 Walnut St Ste 108, Wilmington, NC 28401 Phone: 910-233-1878 | |
Cultivate Wellness Counseling, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3807 Wrightsville Ave Ste 24, Wilmington, NC 28403 Phone: 910-902-9293 Fax: 910-778-1156 | |
The Healing Point, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3205 Randall Pkwy Ste 128, Wilmington, NC 28403 Phone: 910-338-9093 |