# IMPACT LIFELINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467257576
- **Authorized official:** ALISHA MICHELLE JONES NP-C (EXECUTIVE ADMINISTRATOR)
- **Authorized official phone:** (314) 279-4565

## Contact information

- **Practice address:** 205 W 11TH ST, ROLLA, MO 65401-2804
- **Practice address phone:** (314) 279-4565
- **Practice address fax:** (309) 326-4526
- **Mailing address:** 8 LAURELWOOD CT, SAINT LOUIS, MO 63146-4940
- **Mailing address phone:** (314) 279-4565
- **Mailing address fax:** (309) 326-4526

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | NULL | — |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | — | — |
| 251F00000X | Home Infusion Agency | — | NULL | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 02/14/2025
- **Last updated:** 02/19/2025