Provider Demographics
NPI:1902460777
Name:PEARSON, ANGELA M (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:M
Last Name:PEARSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 S FRONTAGE RD STE 112
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-5882
Mailing Address - Country:US
Mailing Address - Phone:601-883-6304
Mailing Address - Fax:601-883-6325
Practice Address - Street 1:2080 S FRONTAGE RD STE 112
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5882
Practice Address - Country:US
Practice Address - Phone:601-883-6303
Practice Address - Fax:601-883-6325
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-27
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904371363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty