Provider Demographics
NPI:1861480501
Name:PEARSON, KAREN LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LEE
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 468
Mailing Address - Street 2:
Mailing Address - City:ALCESTER
Mailing Address - State:SD
Mailing Address - Zip Code:57001-0468
Mailing Address - Country:US
Mailing Address - Phone:605-934-2122
Mailing Address - Fax:
Practice Address - Street 1:104 WEST 2ND STREET
Practice Address - Street 2:
Practice Address - City:ALCESTER
Practice Address - State:SD
Practice Address - Zip Code:57001-0468
Practice Address - Country:US
Practice Address - Phone:605-934-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0391363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS65518Medicare UPIN