Provider Demographics
NPI:1073717252
Name:PEARCE, SHIRLEY ANN (BS, LVN)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:ANN
Last Name:PEARCE
Suffix:
Gender:F
Credentials:BS, LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 E BROWN ST
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79830-3208
Mailing Address - Country:US
Mailing Address - Phone:432-837-3433
Mailing Address - Fax:432-837-7309
Practice Address - Street 1:708 E BROWN ST
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830-3208
Practice Address - Country:US
Practice Address - Phone:432-837-3433
Practice Address - Fax:432-837-7309
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150978164X00000X
TXL9626204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193110702Medicaid
TX193110701Medicaid
TX00X427Medicare PIN