Provider Demographics
NPI:1447230826
Name:PEARSON, TAMMY S (FNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:S
Last Name:PEARSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 SPRINGHILL JUNCTION
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802
Mailing Address - Country:US
Mailing Address - Phone:812-234-6053
Mailing Address - Fax:812-478-3416
Practice Address - Street 1:4525 SPRINGHILL JUNCTION
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802
Practice Address - Country:US
Practice Address - Phone:812-234-6053
Practice Address - Fax:812-478-3416
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001110A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200314670Medicaid
IN200314670Medicaid
IN182200BMedicare ID - Type Unspecified