Provider Demographics
NPI:1508821281
Name:PEARSON, CATHALINE L (PA-C)
Entity Type:Individual
Prefix:
First Name:CATHALINE
Middle Name:L
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34934
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-4934
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9310 S EASTERN AVE
Practice Address - Street 2:SUITE 122
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-6843
Practice Address - Country:US
Practice Address - Phone:702-489-3300
Practice Address - Fax:702-410-9143
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA895363AM0700X
NVPA-C0156363AM0700X
AZ2937363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVFE380ZMedicare PIN
NVQ05516Medicare UPIN