Provider Demographics
NPI:1740673862
Name:PEARSON, NATALIE H (PA-C)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:H
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:H
Other - Last Name:WILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2510 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68826-2123
Mailing Address - Country:US
Mailing Address - Phone:308-946-3845
Mailing Address - Fax:
Practice Address - Street 1:2510 18TH AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:NE
Practice Address - Zip Code:68826-2123
Practice Address - Country:US
Practice Address - Phone:308-946-3845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1900207Q00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1900OtherLICENCE NUMBER