Healthcare Provider Details

I. General information

NPI: 1487808754
Provider Name (Legal Business Name): WENDY C PEARSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 OLD VALDOSTA RD
RAY CITY GA
31645-7132
US

IV. Provider business mailing address

1523 OLD VALDOSTA RD
RAY CITY GA
31645-7132
US

V. Phone/Fax

Practice location:
  • Phone: 877-543-7221
  • Fax:
Mailing address:
  • Phone: 877-543-7221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN244149
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: