Provider Demographics
NPI:1952733149
Name:PEARSON, TERESA K (NP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:K
Last Name:PEARSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:LINDSBORG
Mailing Address - State:KS
Mailing Address - Zip Code:67456
Mailing Address - Country:US
Mailing Address - Phone:785-227-3308
Mailing Address - Fax:785-227-4130
Practice Address - Street 1:605 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:LINDSBORG
Practice Address - State:KS
Practice Address - Zip Code:67456
Practice Address - Country:US
Practice Address - Phone:785-227-3308
Practice Address - Fax:785-227-4130
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76056363LP2300X, 363L00000X
KS5376056363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201083930BMedicaid