| Lifestyle Medical Centers | |
|
1520 Sunday Dr Ste 309 Raleigh NC 27607-5254 | |
| (919) 354-7077 | |
| (919) 354-7075 |
| Full Name | Lifestyle Medical Centers |
|---|---|
| Speciality | Family Medicine |
| Location | 1520 Sunday Dr Ste 309, Raleigh, North Carolina |
| Authorized Official Name and Position | Eric Henderson (SECRETARY) |
| Authorized Official Contact | 9192608423 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifestyle Medical Centers 1520 Sunday Dr Ste 309 Raleigh NC 27607-5254 Ph: (919) 354-7077 | Lifestyle Medical Centers 1520 Sunday Dr Ste 309 Raleigh NC 27607-5254 Ph: (919) 354-7077 |
| NPI Number | 1699029074 |
|---|---|
| Provider Enumeration Date | 11/06/2012 |
| Last Update Date | 02/14/2024 |
| Medicare PECOS PAC ID | 0840588067 |
|---|---|
| Medicare Enrollment ID | O20161004001027 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699029074 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Rachel Vanbree |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295819928 PECOS PAC ID: 9537269030 Enrollment ID: I20070712000834 |
| Provider Name | Bhakti B Paul |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255545190 PECOS PAC ID: 7113097809 Enrollment ID: I20080606000637 |
| Provider Name | Elizabeth H Langston |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1174773840 PECOS PAC ID: 2466516679 Enrollment ID: I20090203000645 |
| Provider Name | Kate Queen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871586206 PECOS PAC ID: 0648368043 Enrollment ID: I20100204000399 |
| Provider Name | Taylor Hollingsworth |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1740616994 PECOS PAC ID: 9436386984 Enrollment ID: I20131209001207 |
| Provider Name | Makayla Flyn Downs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073929980 PECOS PAC ID: 4486873916 Enrollment ID: I20140916001802 |
| Provider Name | Patricia D Butler |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1669860623 PECOS PAC ID: 2264734540 Enrollment ID: I20160104000622 |
| Provider Name | Kimberly A Lee |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1538563168 PECOS PAC ID: 9830494939 Enrollment ID: I20160229000392 |
| Provider Name | Elizabeth Villalta |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1437530193 PECOS PAC ID: 2961790274 Enrollment ID: I20161019000454 |
| Provider Name | Gregory Schiltz |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1679927255 PECOS PAC ID: 1557643186 Enrollment ID: I20170117000034 |
| Provider Name | Anna Mirinda Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972946523 PECOS PAC ID: 2062724842 Enrollment ID: I20180130000974 |
| Provider Name | Alison Licquia |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1700242674 PECOS PAC ID: 4284983925 Enrollment ID: I20180814001901 |
| Provider Name | Emilie Riddle |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1790258176 PECOS PAC ID: 8729326343 Enrollment ID: I20190206001951 |
| Provider Name | Sean Ward |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1053700567 PECOS PAC ID: 0143658880 Enrollment ID: I20200312000301 |
| Provider Name | Saduf J Baig |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1801493820 PECOS PAC ID: 3072913672 Enrollment ID: I20210618001963 |
| Provider Name | Nicholas Ryan Fiacco |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1093042095 PECOS PAC ID: 1557687654 Enrollment ID: I20220512001767 |
| Provider Name | Brandi Crosson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1619605243 PECOS PAC ID: 7416313887 Enrollment ID: I20230510002094 |
| Provider Name | Courtney Locklear Woodside |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1255792602 PECOS PAC ID: 3173989191 Enrollment ID: I20230517003144 |
| Provider Name | Laura Mary Harkins |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1336891068 PECOS PAC ID: 2668838517 Enrollment ID: I20230518001290 |
| Provider Name | Nancy Catherine Dyer |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1164044806 PECOS PAC ID: 9234595125 Enrollment ID: I20230518003143 |
| Provider Name | Hannah Michelle Brewer |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1982383170 PECOS PAC ID: 1254793714 Enrollment ID: I20230815002688 |
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