Provider Demographics
NPI:1619235819
Name:PEARSON, JEANNE LYNN (APRN)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:LYNN
Last Name:PEARSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4013 N RIDGE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-8857
Mailing Address - Country:US
Mailing Address - Phone:316-722-1333
Mailing Address - Fax:316-722-3058
Practice Address - Street 1:4013 N RIDGE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-8857
Practice Address - Country:US
Practice Address - Phone:316-722-1333
Practice Address - Fax:316-722-3058
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75605363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care