Organization
IMPACT LIFELINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALISHA MICHELLE JONES NP-C (EXECUTIVE ADMINISTRATOR)
(314) 279-4565
Entity
Organization
Contact information
Practice address
205 W 11TH ST, ROLLA, MO 65401-2804
(314) 279-4565
(309) 326-4526
Mailing address
8 LAURELWOOD CT, SAINT LOUIS, MO 63146-4940
(314) 279-4565
(309) 326-4526
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
2083P0901X
Public Health & General Preventive Medicine Physician
—
—
251F00000X
Home Infusion Agency
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
02/14/2025
Last updated
02/19/2025
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