Provider Demographics
NPI:1043219918
Name:PEARCE, TERESITA UYTINGEO (PA-C)
Entity Type:Individual
Prefix:
First Name:TERESITA
Middle Name:UYTINGEO
Last Name:PEARCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1694
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28563-1694
Mailing Address - Country:US
Mailing Address - Phone:252-633-4477
Mailing Address - Fax:252-633-2577
Practice Address - Street 1:1413 TATUM DR
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4549
Practice Address - Country:US
Practice Address - Phone:252-633-4477
Practice Address - Fax:252-633-2577
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102215363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS49173Medicare UPIN
NC2744216AMedicare ID - Type Unspecified