Provider Demographics
NPI:1225014012
Name:PEARSON, CYNTHIA LORRAINE I (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LORRAINE
Last Name:PEARSON
Suffix:I
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E GRAY ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3902
Mailing Address - Country:US
Mailing Address - Phone:502-585-2300
Mailing Address - Fax:502-584-2726
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:SUITE 601
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3902
Practice Address - Country:US
Practice Address - Phone:502-585-2300
Practice Address - Fax:502-584-2726
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3851P163WX0800X
IN71001690A163WX0800X
KY1088730163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0800XNursing Service ProvidersRegistered NurseOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78011756Medicaid
IN200337340AMedicaid
KY0239341Medicare ID - Type Unspecified
KY78011756Medicaid
KYP99165Medicare UPIN