Provider Demographics
NPI:1225014012
Name:PEARSON, CYNTHIA LORRAINE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LORRAINE
Last Name:PEARSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ZORN AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1433
Mailing Address - Country:US
Mailing Address - Phone:502-287-4000
Mailing Address - Fax:
Practice Address - Street 1:282 BRULE ST BLDG 875
Practice Address - Street 2:
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121-7008
Practice Address - Country:US
Practice Address - Phone:502-287-6481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003851363L00000X
IN71001690A163WX0800X
KY1088730163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78011756Medicaid
IN200337340AMedicaid
KY0239341Medicare ID - Type Unspecified
KY78011756Medicaid
KYP99165Medicare UPIN