| Lifetime Psychiatry Llc | |
|
5700 Mexico Rd Ste 8 Saint Peters MO 63376-1667 | |
| (636) 477-6464 | |
| (636) 410-9291 |
| Full Name | Lifetime Psychiatry Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5700 Mexico Rd Ste 8, Saint Peters, Missouri |
| Authorized Official Name and Position | Karrie Copeland (PRACTICE MANAGER) |
| Authorized Official Contact | 6364776464 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifetime Psychiatry Llc 5700 Mexico Rd Ste 8 Saint Peters MO 63376-1667 Ph: (636) 477-6464 | Lifetime Psychiatry Llc 5700 Mexico Rd Ste 8 Saint Peters MO 63376-1667 Ph: (636) 477-6464 |
| NPI Number | 1225613557 |
|---|---|
| Provider Enumeration Date | 03/17/2021 |
| Last Update Date | 03/17/2021 |
| Certification Date | 03/17/2021 |
| Medicare PECOS PAC ID | 5496150799 |
|---|---|
| Medicare Enrollment ID | O20210825001437 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225613557 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Nan H Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528172103 PECOS PAC ID: 2567519424 Enrollment ID: I20090409000563 |
| Provider Name | Stacia S Woods |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1780167478 PECOS PAC ID: 8123446036 Enrollment ID: I20200910000828 |
| Provider Name | Jaime Renee Hamilton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992467625 PECOS PAC ID: 8123417417 Enrollment ID: I20211108000283 |
| Provider Name | Beth Marilyn Glenn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003559808 PECOS PAC ID: 4082093083 Enrollment ID: I20220622001835 |
| Provider Name | Candace Danielle Benford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679205140 PECOS PAC ID: 9436535895 Enrollment ID: I20221007002695 |
| Provider Name | Erika Milbner Gotway |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902505795 PECOS PAC ID: 4789043670 Enrollment ID: I20230711000511 |
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