Provider Demographics
NPI:1215321807
Name:PEARSON, AMIE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:AMIE
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:AMIE
Other - Middle Name:
Other - Last Name:PRUITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-1226
Mailing Address - Country:US
Mailing Address - Phone:423-778-7000
Mailing Address - Fax:
Practice Address - Street 1:325 MARKET ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-1226
Practice Address - Country:US
Practice Address - Phone:423-778-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ012731Medicaid