Provider Demographics
NPI:1003200544
Name:PEARSON, JAMIE REBEKAH (BS, MS, CNIM)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:REBEKAH
Last Name:PEARSON
Suffix:
Gender:F
Credentials:BS, MS, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4417 SOCRATES STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031
Mailing Address - Country:US
Mailing Address - Phone:702-748-8807
Mailing Address - Fax:
Practice Address - Street 1:6437 SOUTH POINT DR.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248
Practice Address - Country:US
Practice Address - Phone:844-663-2229
Practice Address - Fax:469-385-8892
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2502246ZE0600X, 2472E0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG
Provider Identifiers
StateIdentifier IDID TypeIssuer
2502OtherCNIM