Provider Demographics
NPI:1457840340
Name:THOMPSON-PEARSALL, ANTISIA LAVETTE (APRN)
Entity type:Individual
Prefix:
First Name:ANTISIA
Middle Name:LAVETTE
Last Name:THOMPSON-PEARSALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ANTISIA
Other - Middle Name:L
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1412 MILSTEAD AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3877
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1412 MILSTEAD AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3877
Practice Address - Country:US
Practice Address - Phone:770-483-9330
Practice Address - Fax:501-664-0889
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005603363LA2100X
GARN299456363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care