Provider Demographics
NPI:1427143593
Name:KLOAC, PEARL (FNP)
Entity type:Individual
Prefix:
First Name:PEARL
Middle Name:
Last Name:KLOAC
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 70 BOX 7397
Mailing Address - Street 2:
Mailing Address - City:SHONTO
Mailing Address - State:AZ
Mailing Address - Zip Code:86054
Mailing Address - Country:US
Mailing Address - Phone:928-672-3057
Mailing Address - Fax:928-672-3062
Practice Address - Street 1:US HWY 98 & NAVAJO ROUTE 16
Practice Address - Street 2:7397
Practice Address - City:SHONTO
Practice Address - State:AZ
Practice Address - Zip Code:86054
Practice Address - Country:US
Practice Address - Phone:928-672-3000
Practice Address - Fax:928-672-3062
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704119567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ494458Medicaid
AZ8HL079OtherMEDICARE WR
AZ8HL080OtherMEDICARE CBQ
AZ494458Medicaid
AZ8HL079OtherMEDICARE WR