Healthcare Provider Details

I. General information

NPI: 1588091664
Provider Name (Legal Business Name): PATRICK PEARSON ATP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4413 TYLER PARK DR STE A
TYLER TX
75703-3123
US

IV. Provider business mailing address

4413 TYLER PARK DR STE A
TYLER TX
75703-3123
US

V. Phone/Fax

Practice location:
  • Phone: 866-858-3300
  • Fax: 888-633-7575
Mailing address:
  • Phone: 866-858-3300
  • Fax: 888-633-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: