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General NPI Number Information
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NPI Number | 1467272344
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Entity Type | Individual
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Provider Name | CANDACE TIERRA PEARSON APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 1488 HIGHWAY 487, SEBASTOPOL, MS 39359
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City | SEBASTOPOL
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State | MS
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Zip | 39359-9055
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Country | US
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Telephone | 601-625-7403
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Fax |
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Provider Business Mailing Address
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Address Line | 805 BENT OAK DR
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City | PEARL
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State | MS
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Zip | 39208-9055
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Country | US
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Telephone | 601-927-0045
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 907007
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 907007
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License Number State | MS
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