| Jessica Lanette Baker, | |
| 
					1706 Wayne Memorial Dr, Goldsboro, NC 27534-2240  | |
| (919) 734-6676 | |
| (919) 238-7919 | 
| Full Name | Jessica Lanette Baker | 
|---|---|
| Gender | Female | 
| Speciality | Social Worker - Clinical | 
| Location | 1706 Wayne Memorial Dr, Goldsboro, North Carolina | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1891405262 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C018035 (North Carolina) | Primary | 
| 1041C0700X | Social Worker - Clinical | P017856 (North Carolina) | Secondary | 
| Entity Name | Lifesource Of North Carolina | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1811286156 PECOS PAC ID: 7416132428 Enrollment ID: O20110505000743  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Jessica Lanette Baker, 1706 Wayne Memorial Dr, Goldsboro, NC 27534-2240 Ph: (919) 734-6676  | Jessica Lanette Baker, 1706 Wayne Memorial Dr, Goldsboro, NC 27534-2240 Ph: (919) 734-6676  | 
Jasmine Detrice Ellison, LCSW-A Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1503 Wayne Memorial Dr Ste E, Goldsboro, NC 27534 Phone: 919-587-0001 Fax: 919-587-0007  | |
Ms. Lakisha King, LCSWA Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1318 Wayne Memorial Dr, Suite A & B, Goldsboro, NC 27534 Phone: 919-734-0753  | |
Mr. Jerome L Ellis,  Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1050 Jabarrah Ave, Seymour Johnson Afb, Goldsboro, NC 27531 Phone: 919-722-0928 Fax: 919-722-1952  | |
Comatha B Johnson, L.C.S.W. Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1705 N Berkeley Blvd, Goldsboro, NC 27534 Phone: 919-751-0277 Fax: 919-751-0278  | |
Pattie Lou Jones, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1706 Wayne Memorial Dr, Goldsboro, NC 27534 Phone: 919-734-6676  | |
Ms. Brianna Nicole Davis, LCSWA Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 1606 Boyette Dr, Goldsboro, NC 27534 Phone: 919-394-3801  | |
Mr. William Lowry Jr.,  Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 307 Beech St, Goldsboro, NC 27530 Phone: 919-731-2119  |