Provider Demographics
NPI:1316293186
Name:PEARCE-WHITLEY, NATALIE J (PA)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:J
Last Name:PEARCE-WHITLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 505164
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5164
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:1229 E SEMINOLE ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2227
Practice Address - Country:US
Practice Address - Phone:417-820-5150
Practice Address - Fax:417-820-5155
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARPA-482207RC0000X
ARP-T1223207RC0000X
MO2013041113363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO132680696Medicare PIN
MO132300471Medicare PIN