Basic Information
| Provider Information | |||||||||
| NPI: | 1689697799 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEARSON | ||||||||
| FirstName: | AIMEE | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 601884 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282601884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9804871148 | ||||||||
| FaxNumber: | 7044877753 | ||||||||
| Practice Location | |||||||||
| Address1: | 1124 N WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | SHELBY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281503862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9804871148 | ||||||||
| FaxNumber: | 7044877753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 05/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 201117 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 155755 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | P00406775 | 01 | NC | RR MEDICARE | OTHER | 1689697799 | 05 | NC | MEDICAID | 7004039 | 05 | NC | MEDICAID | NP1385 | 05 | SC | MEDICAID |