Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Impact Lifeline

Organization Family Medicine Physician · NPI 1467257576

Impact Lifeline is a Family Medicine Physician in Rolla, Missouri. Works from 2 locations. Registered with an NPI since 2025.

In the registry since
2025
Specialties on file
5

Practice location Address checks out

205 W 11th St
Rolla, MO 65401-2804
Phone: (314) 279-4565
Fax: (309) 326-4526
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 13191 Rich Ln, Rolla, MO 65401-7546 — (314) 279-4565

Specialties & licences

Rural Health Clinic/Center (primary) Taxonomy 261QR1300X
Family Medicine Physician Taxonomy 207Q00000X
Public Health & General Preventive Medicine Physician Taxonomy 2083P0901X
Home Infusion Agency Taxonomy 251F00000X
Family Nurse Practitioner Taxonomy 363LF0000X

Record details

NPI number1467257576
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Alisha Jones — Executive Administrator · (314) 279-4565
NPI enumeratedFebruary 14, 2025
Last updated in NPPESFebruary 19, 2025
Certification dateFebruary 19, 2025
Mailing address8 Laurelwood Ct, Saint Louis, MO 63146-4940

Other providers in Rolla