LIFE PRIMARY CARE CLINIC, PLLC (NPI# 1902352123) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902352123 |
| Entity Type | Organization |
| Organization Name | LIFE PRIMARY CARE CLINIC, PLLC |
| Practice Address |
550 River Street Grimesland NC 27837 |
| Mailing Address |
Po Box 87 Grimesland NC 27837-0087 |
| Practice Telephone | 2527580602 |
| Practice Fax Number | 2523299002 |
| Mailing Telephone | 2527580602 |
| Mailing Fax Number | 2523299002 |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2016-10-08 |
| Authorized Official Name | MRS. VANESSA H COX (CLINICAL MANAGER) |
| Authorized Official Telephone | 2529163645 |
| Authorized Official Credential | RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
5005487 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 7006027 | 05 |
| Street Address |
550 RIVER STREET |
| City | GRIMESLAND |
| State | NC |
| Zip Code | 27837 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164424917 | Greene County Health Care Incorporated | Clinic/Center | 550 River Street, Grimesland, NC 27837 | 2005-08-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508138199 | Kimberly Dawn Ennis | Social Worker | 513 Lancelot Street, Grimesland, NC 27837-0567 | 2012-01-30 |
| 1790107357 | Tracey Lee Smith | Physician Assistant | 1970-c West Arlington Blvd, Greenville, NC 27837-5783 | 2014-01-15 |
| 1609204585 | Charley Tyre | Nurse Practitioner | 2627 Winding Cv, Grimesland, NC 27837-8612 | 2013-10-31 |
| 1467078907 | Morgan Sutton | Student in an Organized Health Care Education/Training Program | 221 Tripp Trl, Grimesland, NC 27837-8701 | 2020-06-21 |
| 1598108664 | George Brian Harris | Counselor | 2812 Mobleys Bridge Rd, Grimesland, NC 27837-8832 | 2013-04-09 |
| 1396912986 | Diane K. Bradshaw | Counselor | 367 Great Forest Rd, Grimesland, NC 27837-9049 | 2008-05-13 |
| 1265621049 | Life Options | Health Maintenance Organization | 4743 Ariel Dr, Grimesland, NC 27837-9107 | 2007-10-17 |
| 1942504428 | Robersonville Psychosocial Rehabilitation LLC | Community/Behavioral Health | 3709 Barton Way, Grimesland, NC 27837-9159 | 2010-12-27 |
| 1275917924 | 3s Therapy, P.C. | Speech-Language Pathologist | 3116 Juniper Branch Dr, Grimesland, NC 27837-9167 | 2015-07-13 |
| 1508143512 | Latonya Harris Grimes | Social Worker | 642 Broadmoor Ct, Grimesland, NC 27837-9188 | 2011-11-05 |
| Find all providers in zip 27837 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295334647 | Kennitrish Nickola Bracey | Nurse Practitioner | 5124 Red Poll Dr, Greensboro, NC 27405-9794 | 2020-10-17 |
| 1255947974 | Alice Lorraine Fagan | Nurse Practitioner | 2130 Highland View Ln, Charlotte, NC 28214-9425 | 2020-09-17 |
| 1689286270 | Meylien Delgado Lee | Nurse Practitioner | 510 S Spruce St, Wilkesboro, NC 28697-2846 | 2020-08-17 |
| 1124638317 | Jakita Strong | Nurse Practitioner | 1506 Ladora Dr, Charlotte, NC 28262-6414 | 2020-08-03 |
| 1689284820 | Corrie Hansen | Nurse Practitioner | 1700 Tarboro St W Ste 100, Wilson, NC 27893-3481 | 2020-08-03 |
| 1609490382 | Brooke Martin Shaw | Nurse Practitioner | 5514, 350 N Cox St, Ste 6, Asheboro, NC 27203 | 2020-05-29 |
| 1467075440 | Lydia A. Teague | Nurse Practitioner | 120 N Medical Drive Unc-ch Son: Carrington Hall Chapel, Chapel Hill, NC 27599-0001 | 2020-05-25 |
| 1689209710 | Ana Rita Frey | Nurse Practitioner | 601 E 5th St Ste 140, Charlotte, NC 28202-3092 | 2020-03-09 |
| 1578109427 | Mia Licole Saulter | Nurse Practitioner | 3961 Stafford Run Ct, High Point, NC 27265-9480 | 2019-11-25 |
| 1801430715 | Erica Nicole Ebohon | Nurse Practitioner | 3803 Arundel Ct, Greensboro, NC 27406-9832 | 2019-11-04 |
| Find all providers with the same taxonomy | ||||
| City | GRIMESLAND |
| Zip Code | 27837 |
Please comment or provide details below to improve the information on LIFE PRIMARY CARE CLINIC, PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.