Provider Demographics
NPI:1619785052
Name:PEARCE, KAILEY VISOSKI (MSBE)
Entity type:Individual
Prefix:MRS
First Name:KAILEY
Middle Name:VISOSKI
Last Name:PEARCE
Suffix:
Gender:F
Credentials:MSBE
Other - Prefix:
Other - First Name:KAILEY
Other - Middle Name:BROOKE
Other - Last Name:VISOSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2323 N CENTRAL EXPY
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2712
Mailing Address - Country:US
Mailing Address - Phone:214-453-4533
Mailing Address - Fax:
Practice Address - Street 1:2323 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2712
Practice Address - Country:US
Practice Address - Phone:214-453-4533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant