Provider Demographics
NPI:1770544199
Name:PEARLMAN, STACEY B (PA)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:B
Last Name:PEARLMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 ROUND HILL RD
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-5747
Mailing Address - Country:US
Mailing Address - Phone:972-832-7440
Mailing Address - Fax:
Practice Address - Street 1:7401 ROUND HILL RD
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-5747
Practice Address - Country:US
Practice Address - Phone:972-832-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MA1790363AM0700X
TXPA03099363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218994602Medicaid
TX218994601Medicaid
MAP47583Medicare UPIN
MAAP2270Medicare ID - Type UnspecifiedMEDICARE NUMBER
TXTXB117506Medicare PIN
TXTXB117507Medicare PIN