Provider Demographics
NPI:1750920542
Name:PEARL-WINTERS, SHONDA DENISE (FNP-C)
Entity type:Individual
Prefix:
First Name:SHONDA
Middle Name:DENISE
Last Name:PEARL-WINTERS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 LISA DRIVE EXT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-4429
Mailing Address - Country:US
Mailing Address - Phone:662-334-2929
Mailing Address - Fax:
Practice Address - Street 1:1907 LISA DRIVE EXT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-4429
Practice Address - Country:US
Practice Address - Phone:662-334-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSF12190556363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily