Provider Demographics
NPI:1962418491
Name:PEARSON, MARTHA ANN (ARNP)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:ANN
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 1:1030 MONARCH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1843
Mailing Address - Country:US
Mailing Address - Phone:859-296-3141
Mailing Address - Fax:859-296-3144
Practice Address - Street 1:1030 MONARCH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1899
Practice Address - Country:US
Practice Address - Phone:859-296-3141
Practice Address - Fax:859-296-3144
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002520364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent