Basic Information
| Provider Information | |||||||||
| NPI: | 1003291246 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEARSON | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | NICHO | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 SUNSET RIDGE DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | ROCKWALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750320007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727725450 | ||||||||
| FaxNumber: | 9727725452 | ||||||||
| Practice Location | |||||||||
| Address1: | 2701 SUNSET RIDGE DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | ROCKWALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750320007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727725450 | ||||||||
| FaxNumber: | 9727725452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2015 | ||||||||
| LastUpdateDate: | 03/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA09939 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.