| Lifesource Prime Inc | |
|
3205 Randall Pkwy Ste 105 Wilmington NC 28403-2565 | |
| (910) 742-9243 | |
| (888) 746-1787 |
| Full Name | Lifesource Prime Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 3205 Randall Pkwy Ste 105, Wilmington, North Carolina |
| Authorized Official Name and Position | Peggy Baddour (CEO) |
| Authorized Official Contact | 9107429243 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifesource Prime Inc Po Box 740343 Atlanta GA 30374-0343 Ph: (910) 338-2882 | Lifesource Prime Inc 3205 Randall Pkwy Ste 105 Wilmington NC 28403-2565 Ph: (910) 742-9243 |
| NPI Number | 1598533275 |
|---|---|
| Provider Enumeration Date | 12/13/2023 |
| Last Update Date | 10/28/2025 |
| Medicare PECOS PAC ID | 7810336385 |
|---|---|
| Medicare Enrollment ID | O20240416003922 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598533275 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | James William Earnhardt |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1992756019 PECOS PAC ID: 3779569991 Enrollment ID: I20040628001383 |
| Provider Name | Paul Ziomek |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548357908 PECOS PAC ID: 7719955343 Enrollment ID: I20051206000961 |
| Provider Name | Sachin S Mody |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730106444 PECOS PAC ID: 7214932482 Enrollment ID: I20070409000492 |
| Provider Name | Karen Stukes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831376433 PECOS PAC ID: 0244314524 Enrollment ID: I20080226000122 |
| Provider Name | Cynthia K Honeycutt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528215407 PECOS PAC ID: 3375602980 Enrollment ID: I20081111000281 |
| Provider Name | Janet L Poindexter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578564803 PECOS PAC ID: 7618967282 Enrollment ID: I20090117000112 |
| Provider Name | Monica B Massey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720256928 PECOS PAC ID: 8022289123 Enrollment ID: I20110921000677 |
| Provider Name | Andrew Thomas Martin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801096821 PECOS PAC ID: 0244403079 Enrollment ID: I20130223000120 |
| Provider Name | Amy H Hudson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821344060 PECOS PAC ID: 6901041086 Enrollment ID: I20130320000140 |
| Provider Name | Rebecca Spring Stevens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275968216 PECOS PAC ID: 7416182795 Enrollment ID: I20131022000507 |
| Provider Name | Crystal Prince Ostheim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821490434 PECOS PAC ID: 5890019699 Enrollment ID: I20150127002361 |
| Provider Name | Jatel Shukla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467854224 PECOS PAC ID: 6204154628 Enrollment ID: I20150415002118 |
| Provider Name | Megan Katherine Blankenship |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366969834 PECOS PAC ID: 4880960970 Enrollment ID: I20171017002159 |
| Provider Name | Jennifer Lauren Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740762947 PECOS PAC ID: 0547513574 Enrollment ID: I20181022001455 |
| Provider Name | Julia Marie Cibula |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649458787 PECOS PAC ID: 2466421706 Enrollment ID: I20181120000072 |
| Provider Name | Felicia Harrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497130306 PECOS PAC ID: 6002125101 Enrollment ID: I20181228000547 |
| Provider Name | Andrea Unzelmann Putnam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376011403 PECOS PAC ID: 1355687708 Enrollment ID: I20190107002266 |
| Provider Name | Megan D Long |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952950859 PECOS PAC ID: 0941633382 Enrollment ID: I20191126000062 |
| Provider Name | William B Holder |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316168602 PECOS PAC ID: 7911332838 Enrollment ID: I20200122002148 |
| Provider Name | Nacole H Wood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356932974 PECOS PAC ID: 8729495130 Enrollment ID: I20210401000379 |
| Provider Name | Tayler Gabrielle Mebane |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164192597 PECOS PAC ID: 5092105585 Enrollment ID: I20211123002307 |
| Provider Name | Ishan Bhansaly |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972824357 PECOS PAC ID: 6507004157 Enrollment ID: I20220203001128 |
| Provider Name | Joel Marvin Hart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497746697 PECOS PAC ID: 4880680099 Enrollment ID: I20220804000863 |
| Provider Name | Diana Marmolejos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467094821 PECOS PAC ID: 6204260979 Enrollment ID: I20230112001229 |
| Provider Name | Erica Braswell Kearney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205467586 PECOS PAC ID: 3779954185 Enrollment ID: I20230123001842 |
| Provider Name | Patricia Kpan Yates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104018969 PECOS PAC ID: 0648641936 Enrollment ID: I20230124003168 |
| Provider Name | Cherise Dailey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396445854 PECOS PAC ID: 6901271519 Enrollment ID: I20230413001496 |
| Provider Name | Brittany Lashay Hicklen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801596572 PECOS PAC ID: 6103282827 Enrollment ID: I20230522002485 |
| Provider Name | Kari A Spencer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457929903 PECOS PAC ID: 3779946124 Enrollment ID: I20230831004196 |
| Provider Name | Megan Wolff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568114650 PECOS PAC ID: 2466831524 Enrollment ID: I20230918002735 |
| Provider Name | Courtney Demaiya Saunders |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881311306 PECOS PAC ID: 0042658015 Enrollment ID: I20240410000352 |
| Provider Name | Debra Denise Arthur Turner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376258384 PECOS PAC ID: 9436699469 Enrollment ID: I20240905001744 |
| Provider Name | Chacey Bryan |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1699228734 PECOS PAC ID: 9234425885 Enrollment ID: I20241009002580 |
| Provider Name | Deborah Sadek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790487577 PECOS PAC ID: 5193173342 Enrollment ID: I20250106003348 |
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