Individual provider Active NPI

Barbara Ann Pearce, ANP-C

  • Adult Health Nurse Practitioner
  • Valdosta, GA
National Provider Identifier
1023158763
Registry record updated Sep 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
RN054555 NP Issued in GA
Practice address
4233 Camelot Xing
Valdosta, GA 31602-6926
Phone
(229) 469-4383
Fax
(229) 469-4584
NPI assigned
Feb 8, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 30, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X RN054555 NP GA Primary

Addresses

Primary practice location

4233 Camelot Xing
Valdosta, GA 31602-6926

Mailing address

4233 Camelot Xing
Valdosta, GA 31602-6926
Phone (229) 469-4383

Other identifiers 1

IdentifierTypeStateIssuer
00741914BMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN054555 NPGAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Thacker Dermatology LLC CurrentSince Oct 6, 2019 Accepting new patients
Premise Health of Georgia Medical PC Past Accepting new patients

Locations

4233 Camelot Xing
Valdosta, GA 31602
Phone (229) 469-4383

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569801600000",
    "number": "1023158763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4233 CAMELOT XING",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316026926",
            "telephone_number": "229-469-4383",
            "fax_number": "229-469-4584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4233 CAMELOT XING",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316026926",
            "telephone_number": "229-469-4383",
            "fax_number": "229-469-4584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEARCE",
        "first_name": "BARBARA",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "ANP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-08",
        "last_updated": "2019-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "RN054555 NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00741914B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.