Provider Demographics
NPI:1508523424
Name:PEARSON, LAUREN ELIZABETH
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:PEARSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2036
Mailing Address - Country:US
Mailing Address - Phone:601-540-0872
Mailing Address - Fax:
Practice Address - Street 1:516 W OAKLAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-1677
Practice Address - Country:US
Practice Address - Phone:423-888-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-27
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201402144RN251J00000X
OR202212408NP-PP363L00000X
TN32177363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN264212OtherTN NURSING LICENSE
TN32177OtherAPRN LICENSE
OR201402144RNOtherRN NURSING LICENSE
OR202212408NP-PPOtherAPRN LICENSE