Provider Demographics
NPI:1487808754
Name:PEARSON, WENDY C (ARNP)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:C
Last Name:PEARSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 OLD VALDOSTA RD
Mailing Address - Street 2:
Mailing Address - City:RAY CITY
Mailing Address - State:GA
Mailing Address - Zip Code:31645-7132
Mailing Address - Country:US
Mailing Address - Phone:877-543-7221
Mailing Address - Fax:
Practice Address - Street 1:1523 OLD VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:RAY CITY
Practice Address - State:GA
Practice Address - Zip Code:31645-7132
Practice Address - Country:US
Practice Address - Phone:877-543-7221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
GARN244149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA234742011BMedicaid
GARN244149OtherBOARD OF NURSING