Provider Demographics
NPI:1114445764
Name:PEARSON, LESLIE B (NP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:B
Last Name:PEARSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 SOUTHCREST CIR STE 212
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-6721
Mailing Address - Country:US
Mailing Address - Phone:662-245-5270
Mailing Address - Fax:662-351-9471
Practice Address - Street 1:401 SOUTHCREST CIR STE 212
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6721
Practice Address - Country:US
Practice Address - Phone:662-245-5270
Practice Address - Fax:662-351-9471
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902137363LF0000X
TN23129363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS802857320OtherDRIVER LICENSE