Xavier Jacob Lee Pearson, MS, RD, LD, CNSC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

2014031795 Issued in MO

Practice address

1500 N Oakland Ave
Bolivar, MO 65613-3011

Phone

(417) 328-6462

NPI assigned

Aug 5, 2022

Last updated

Aug 5, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1659657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659657600000",
    "number": "1316674609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "776 W PEARL ST",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656132878",
            "telephone_number": "417-298-1366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 N OAKLAND AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656133011",
            "telephone_number": "417-328-6462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEARSON",
        "first_name": "XAVIER",
        "middle_name": "JACOB LEE",
        "name_prefix": "Mr.",
        "credential": "MS, RD, LD, CNSC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-05",
        "last_updated": "2022-08-05",
        "certification_date": "2022-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MO",
            "license": "2014031795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karona Paschke, FNP-C
• Caressa R Patel, PA-C
• Naiya Patel
• Casey Marie Peak, MS, LPC
• Nathaniel Alan Pearl, DO
• Jonna Marie Pendergrass, RN
• Malissa Phillips, FNP
• Charles Allan Pitts
• Jacob Podleski
• Polk County Health Center

• Registered Dietitian in Bolivar, MO
• Providers in Bolivar, MO by specialty
• Registered Dietitian in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2022; 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.