Provider Demographics
NPI:1083034276
Name:PEARSON, KALI (RDN)
Entity Type:Individual
Prefix:
First Name:KALI
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6767 S SPRUCE ST STE 125
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1284
Mailing Address - Country:US
Mailing Address - Phone:303-779-9355
Mailing Address - Fax:303-779-0956
Practice Address - Street 1:6767 S SPRUCE ST STE 125
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1284
Practice Address - Country:US
Practice Address - Phone:303-779-9355
Practice Address - Fax:303-779-0956
Is Sole Proprietor?:No
Enumeration Date:2014-04-26
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86006656133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO382334YL7XMedicare PIN