Basic Information
| Provider Information | |||||||||
| NPI: | 1003998659 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEARSON | ||||||||
| FirstName: | ADON | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 168 NORTH 100 EAST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ST. GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847702893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4359862565 | ||||||||
| FaxNumber: | 4359862577 | ||||||||
| Practice Location | |||||||||
| Address1: | 168 NORTH 100 EAST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ST. GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847702893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4359862565 | ||||||||
| FaxNumber: | 4359862577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 07/26/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA1011 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 285003-1205 | UT | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 3674 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | PA1011 | 01 | NV | LICENSE | OTHER |