Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN054555 NP | GA |
NPI | 1023158763 |
---|---|
Provider Name | Ms. Barbara Ann Pearce |
First Address | Valdosta, GA 31602-6926 |
Second Address | Valdosta, GA 31602-6926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 30/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00741914B | (05) | GA |
S48329 | (02) | GA |