Provider Demographics
NPI:1992390462
Name:PEARSON, LAUREN ALLYSON
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALLYSON
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 1:301 W PLUM ST APT 10
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-3349
Mailing Address - Country:US
Mailing Address - Phone:469-925-4223
Mailing Address - Fax:
Practice Address - Street 1:301 W PLUM ST APT 10
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3349
Practice Address - Country:US
Practice Address - Phone:469-925-4223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist