Provider Demographics
NPI:1588420855
Name:PEARSON, MISTY LYNNE
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:LYNNE
Last Name:PEARSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 E BROADWAY AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4740
Mailing Address - Country:US
Mailing Address - Phone:701-720-2627
Mailing Address - Fax:
Practice Address - Street 1:33085 72ND ST SW
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:ND
Practice Address - Zip Code:58735-9411
Practice Address - Country:US
Practice Address - Phone:701-721-3918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist