Healthcare Provider Details

I. General information

NPI: 1003433723
Provider Name (Legal Business Name): DALE D PEARCE APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 W MCCORD ST
CENTRALIA IL
62801-5805
US

IV. Provider business mailing address

415 E 200 AVE
PATOKA IL
62875-0045
US

V. Phone/Fax

Practice location:
  • Phone: 618-533-1811
  • Fax:
Mailing address:
  • Phone: 618-322-8391
  • Fax: 618-532-8171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209020476
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: