Provider Demographics
NPI:1215378625
Name:PEARSON, CHRISTIAN LUCAS (LMT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:LUCAS
Last Name:PEARSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 HEPBURN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1613
Mailing Address - Country:US
Mailing Address - Phone:812-701-0821
Mailing Address - Fax:
Practice Address - Street 1:1325 HEPBURN AVE APT 1
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1613
Practice Address - Country:US
Practice Address - Phone:812-701-0821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-13
Last Update Date:2013-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-4659364SH1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SH1100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHolistic