Provider Demographics
NPI:1215378807
Name:PEARSON, NATHAN EDWARD (FNP)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:EDWARD
Last Name:PEARSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 ARKANSAS RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-8694
Mailing Address - Country:US
Mailing Address - Phone:318-397-7000
Mailing Address - Fax:318-537-9049
Practice Address - Street 1:2809 ARKANSAS RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-8694
Practice Address - Country:US
Practice Address - Phone:318-397-7000
Practice Address - Fax:318-537-9049
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07382363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP07382OtherFNP CERT # F0613569