Healthcare Provider Details

I. General information

NPI: 1083372296
Provider Name (Legal Business Name): RAKELIA PEARSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2021
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1943 FORT CAMPBELL BLVD STE A
CLARKSVILLE TN
37042-3691
US

IV. Provider business mailing address

838 WINSLOW ST
CLARKSVILLE TN
37042-5811
US

V. Phone/Fax

Practice location:
  • Phone: 931-494-8081
  • Fax: 931-919-2904
Mailing address:
  • Phone: 478-731-8226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number43158
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number257121
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number257121
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number257121
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: