Provider Demographics
NPI:1164481362
Name:PEARSON, MELISSA D (ARNP)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:D
Last Name:PEARSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E BUCHANAN ST
Mailing Address - Street 2:P.O. BOX 188
Mailing Address - City:BAXTER
Mailing Address - State:IA
Mailing Address - Zip Code:50028
Mailing Address - Country:US
Mailing Address - Phone:641-227-3045
Mailing Address - Fax:641-227-3356
Practice Address - Street 1:208 E BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:IA
Practice Address - Zip Code:50028
Practice Address - Country:US
Practice Address - Phone:641-227-3045
Practice Address - Fax:641-227-3356
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098752363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0481473Medicaid