Kenneth Duane Pearson
Individual provider Active NPI Driver · Sandstone, MN
NPI 1265119978 · NPPES record last updated Jul 4, 2023
Key facts
- NPI
- 1265119978
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- Z716244577114 (MN)
- Practice address
- 606 Highway 123 W
Sandstone, MN 55072-5060 - Phone
- (320) 245-5355
- Fax
- (320) 216-7638
- NPI assigned
- Jul 4, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| Z716244577114 | MN | MD | Driver |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Red Lion Therapy & Consultation, LLC | Current |
Accepting new patients | |
| Attaboys, Inc | Current |
Accepting new patients |
Locations
606 Highway 123 W
Sandstone, MN 55072
Phone (320) 204-5535
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | Z716244577114 | MN | Yes |
Addresses
Primary practice location
606 Highway 123 W
Sandstone, MN 55072-5060
Mailing address
PO Box 26
Sandstone, MN 55072-0026
Phone (320) 245-5355
Other providers in Sandstone, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 4, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.