Provider Demographics
NPI:1700960325
Name:PEARSON, JAMIE MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARIE
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 1:18444 N 25TH AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1266
Mailing Address - Country:US
Mailing Address - Phone:866-974-2673
Mailing Address - Fax:866-939-2673
Practice Address - Street 1:3200 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2255
Practice Address - Country:US
Practice Address - Phone:928-583-6300
Practice Address - Fax:928-774-7767
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5613363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN61G04PEOtherBCBS MN
MNHP48207OtherHEALTHPARTNERS
MN61G05PEOtherBCBS MN PROFEE
MNNA9031030242OtherPREFERRED ONE
WI004880098Medicare ID - Type Unspecified
MN270731400Medicaid
MN01-11840OtherMEDICA
WIP56769Medicare UPIN
WI41957300Medicaid