| Lifesource Of North Carolina | |
|
1728 W 8th St Cedar Falls IA 50613-2002 | |
| (910) 742-9243 | |
| (888) 746-1787 |
| Full Name | Lifesource Of North Carolina |
|---|---|
| Speciality | Social Worker |
| Location | 1728 W 8th St, Cedar Falls, Iowa |
| Authorized Official Name and Position | Peggy Baddour (PRESIDENT) |
| 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 Atlanta GA 30353-8622 Ph: (910) 742-9243 | Lifesource Of North Carolina 1728 W 8th St Cedar Falls IA 50613-2002 Ph: (910) 742-9243 |
| NPI Number | 1801431440 |
|---|---|
| Provider Enumeration Date | 11/07/2019 |
| Last Update Date | 03/26/2021 |
| Certification Date | 03/26/2021 |
| Medicare PECOS PAC ID | 7416132428 |
|---|---|
| Medicare Enrollment ID | O20200116001140 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801431440 | NPI | - | NPPES |
| Provider Name | Dieter Boxmann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023178548 PECOS PAC ID: 5092733428 Enrollment ID: I20070917000040 |
| Provider Name | Kimberly Cafaro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942642426 PECOS PAC ID: 5890926208 Enrollment ID: I20180810001904 |
| Provider Name | Ekaete Oyeka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366093692 PECOS PAC ID: 7618304247 Enrollment ID: I20200220002453 |
| Provider Name | James Gilder Bouknight |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174584916 PECOS PAC ID: 3476525593 Enrollment ID: I20200326000831 |
| Provider Name | Justine Uselding |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932219284 PECOS PAC ID: 5597766881 Enrollment ID: I20200504001277 |
| Provider Name | Amy Mitchell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992340970 PECOS PAC ID: 5294620464 Enrollment ID: I20200526000512 |
| Provider Name | Bryce Yates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487184446 PECOS PAC ID: 4688931298 Enrollment ID: I20210303001691 |
| Provider Name | Melissa Gambrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821492869 PECOS PAC ID: 3274853072 Enrollment ID: I20210318000912 |
| Provider Name | Erin Honke |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093088312 PECOS PAC ID: 5890068977 Enrollment ID: I20210811001720 |
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