Provider Demographics
NPI:1407945355
Name:PEARSON, INGRID PATRICIA (MS RN CPNP)
Entity Type:Individual
Prefix:MS
First Name:INGRID
Middle Name:PATRICIA
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MS RN CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BATESBURG-LEESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29006-2107
Mailing Address - Country:US
Mailing Address - Phone:803-532-2208
Mailing Address - Fax:803-604-0207
Practice Address - Street 1:120 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:BATESBURG
Practice Address - State:SC
Practice Address - Zip Code:29006-2107
Practice Address - Country:US
Practice Address - Phone:803-532-2208
Practice Address - Fax:803-604-0207
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1003363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0181Medicaid
SCNP0181Medicaid