Healthcare Provider Details

I. General information

NPI: 1316857543
Provider Name (Legal Business Name): MARCEL ANTONETTE PEARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7897 COUNTRY LAKE DR
BARTLETT TN
38133-2767
US

IV. Provider business mailing address

7897 COUNTRY LAKE DR
BARTLETT TN
38133-2767
US

V. Phone/Fax

Practice location:
  • Phone: 901-494-9114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number42864
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: