Provider Demographics
NPI:1689681942
Name:PEARSON, CYNTHIA (FNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
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:P.O. BOX 298
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35631-0298
Mailing Address - Country:US
Mailing Address - Phone:256-767-7494
Mailing Address - Fax:256-765-0377
Practice Address - Street 1:123 ALCORN DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9359
Practice Address - Country:US
Practice Address - Phone:662-286-2866
Practice Address - Fax:662-286-2864
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR851921363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06430512Medicaid
MS2656050Medicaid
512I500564Medicare PIN