Healthcare Provider Details

I. General information

NPI: 1356275770
Provider Name (Legal Business Name): MS. GINA MARIE PEARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 S CARSON AVE
TULSA OK
74119-4610
US

IV. Provider business mailing address

5103 S SHERIDAN RD PMB 611
TULSA OK
74145-7627
US

V. Phone/Fax

Practice location:
  • Phone: 918-406-3420
  • Fax:
Mailing address:
  • Phone: 918-406-3420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: