| Recon Neurology & Psychiatry | |
|
1340 Walter Reed Rd Ste 202 Fayetteville NC 28304-4451 | |
| (910) 504-3506 | |
| (910) 504-3507 |
| Full Name | Recon Neurology & Psychiatry |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1340 Walter Reed Rd Ste 202, Fayetteville, North Carolina |
| Authorized Official Name and Position | Lisa Hudson (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 9103726172 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Recon Neurology & Psychiatry 1340 Walter Reed Rd Ste 202 Fayetteville NC 28304-4451 Ph: (910) 504-3506 | Recon Neurology & Psychiatry 1340 Walter Reed Rd Ste 202 Fayetteville NC 28304-4451 Ph: (910) 504-3506 |
| NPI Number | 1427769140 |
|---|---|
| Provider Enumeration Date | 12/13/2022 |
| Last Update Date | 09/12/2025 |
| Certification Date | 09/12/2025 |
| Medicare PECOS PAC ID | 3870965924 |
|---|---|
| Medicare Enrollment ID | O20230217002468 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427769140 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Pamela L Herbig Wall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033386446 PECOS PAC ID: 4880971167 Enrollment ID: I20170516000809 |
| Provider Name | Matthew Kyle Banks |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1659772069 PECOS PAC ID: 4082942750 Enrollment ID: I20190820002809 |
| Provider Name | Ngu Wah Aung |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760741961 PECOS PAC ID: 0941582076 Enrollment ID: I20190910000650 |
| Provider Name | Jessica Wood Fleishman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679288260 PECOS PAC ID: 8123460169 Enrollment ID: I20240522003323 |
| Provider Name | Elizabeth Monis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750901484 PECOS PAC ID: 5799108221 Enrollment ID: I20241106003424 |
| Provider Name | Cheryl Dodson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386452837 PECOS PAC ID: 3375065493 Enrollment ID: I20250318003701 |
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