Provider Demographics
NPI:1083784102
Name:PEARCE, ELSA C (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ELSA
Middle Name:C
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 1:6222 LOST CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-2955
Mailing Address - Country:US
Mailing Address - Phone:361-737-3072
Mailing Address - Fax:
Practice Address - Street 1:1722 9TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5003
Practice Address - Country:US
Practice Address - Phone:940-322-1075
Practice Address - Fax:940-761-3832
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03643207P00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ39827Medicare UPIN
TX8K3911Medicare PIN