Provider Demographics
NPI:1639653934
Name:PEARSON, STACEY (RN, BSN)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:284 EXECUTIVE PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1833
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1120
Practice Address - Street 1:116 S LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-3657
Practice Address - Country:US
Practice Address - Phone:910-895-2462
Practice Address - Fax:910-895-9896
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC263747364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family