Nokomis Natavia Lazenberry, is a medicare enrolled "Behavior Technician" provider in St Augustine, Florida. Her current practice location is
2101 Arc Dr, St Augustine, Florida. You can reach out to her office (for appointments etc.) via phone at
(904) 824-7249.
Nokomis Natavia Lazenberry is licensed to practice in * (Not Available) (license number ) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1154865038.
Healthcare Provider's Profile
| Full Name | Nokomis Natavia Lazenberry |
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| Gender | Female |
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| Speciality | Behavior Technician |
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| Location | 2101 Arc Dr, St Augustine, Florida |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1154865038
- Provider Enumeration Date: 12/12/2016
- Last Update Date: 08/02/2024
Medicare PECOS Information:
- PECOS PAC ID: 9739629544
- Enrollment ID: I20240907000409
Medical Identifiers
Medical identifiers for Nokomis Natavia Lazenberry such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1154865038 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YM0800X | Counselor - Mental Health | MH24067 (Florida) | Secondary |
| 106S00000X | Behavior Technician | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Nokomis Natavia Lazenberry allows following entities to bill medicare on her behalf.
| Entity Name | Grow Healthcare Group Pa |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1245845932
PECOS PAC ID: 3476961368
Enrollment ID: O20210414000053 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Nokomis Natavia Lazenberry is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Nokomis Natavia Lazenberry,
2101 Arc Dr,
St Augustine, FL 32084-0512
Ph: (904) 824-7249 | Nokomis Natavia Lazenberry,
2101 Arc Dr,
St Augustine, FL 32084-0512
Ph: (904) 824-7249 |
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