Healthcare Provider Details

I. General information

NPI: 1649854076
Provider Name (Legal Business Name): JENNIFER PEARSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S PIONEER WAY
MOSES LAKE WA
98837-4613
US

IV. Provider business mailing address

1616 S PIONEER WAY
MOSES LAKE WA
98837-2487
US

V. Phone/Fax

Practice location:
  • Phone: 509-793-9780
  • Fax: 509-764-3245
Mailing address:
  • Phone: 509-793-9715
  • Fax: 509-764-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.AP.70004819-NP
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-3199
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70004819
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: