Provider Demographics
NPI:1962400655
Name:PEARSON, JOHN THOMAS (FNP-C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:THOMAS
Last Name:PEARSON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 S DUPONT HWY
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-6405
Mailing Address - Country:US
Mailing Address - Phone:302-698-1100
Mailing Address - Fax:302-698-1187
Practice Address - Street 1:4601 S DUPONT HWY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-6405
Practice Address - Country:US
Practice Address - Phone:302-698-1100
Practice Address - Fax:302-698-1187
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0000349363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000034447Medicaid
DE014984G37Medicare ID - Type Unspecified
DEQ18046Medicare UPIN