Provider Demographics
NPI:1861130874
Name:PEARSEY, KATRINA LOUISE
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:LOUISE
Last Name:PEARSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:L
Other - Last Name:CASSIDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:GAYLESVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35973-0014
Mailing Address - Country:US
Mailing Address - Phone:256-706-0296
Mailing Address - Fax:
Practice Address - Street 1:1838 REDMOND RD
Practice Address - Street 2:SUITE B &C
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165
Practice Address - Country:US
Practice Address - Phone:334-685-1496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-151126163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse