Provider Demographics
NPI:1770365306
Name:PEARSON, KELSEY JOAN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:JOAN
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5845 E LAVENDER CT
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-3358
Mailing Address - Country:US
Mailing Address - Phone:714-743-7559
Mailing Address - Fax:
Practice Address - Street 1:5845 E LAVENDER CT
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-3358
Practice Address - Country:US
Practice Address - Phone:714-743-7559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95242273163W00000X
CA95027578363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95027578OtherNURSE PRACTITIONER/FURNISHING
CA95242273OtherREGISTERED NURSE