Provider Demographics
NPI:1437166766
Name:PEARSON, KIM ALAN (NURSE ANESTHETIST)
Entity type:Individual
Prefix:MR
First Name:KIM
Middle Name:ALAN
Last Name:PEARSON
Suffix:
Gender:M
Credentials:NURSE ANESTHETIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2446 NEWPORT CIRCLE
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-9146
Mailing Address - Country:US
Mailing Address - Phone:641-672-1309
Mailing Address - Fax:
Practice Address - Street 1:1229 C AVENUE EAST
Practice Address - Street 2:MAHASKA HEALTH PARTNERSHIP
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-9146
Practice Address - Country:US
Practice Address - Phone:641-672-3100
Practice Address - Fax:641-672-3215
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD061933367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0122051Medicaid
IA0102OtherJOHN DEERE
50829OtherWELLMARK BCBS
IA0122051Medicaid