Provider Demographics
NPI:1730960105
Name:PEARCE, NICKALUS
Entity type:Individual
Prefix:
First Name:NICKALUS
Middle Name:
Last Name:PEARCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BIRCHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4189
Mailing Address - Country:US
Mailing Address - Phone:931-709-0661
Mailing Address - Fax:
Practice Address - Street 1:5756 HIGHWAY 153 STE 116
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5246
Practice Address - Country:US
Practice Address - Phone:423-876-4443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1058237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist