Active NPI
Kenneth Pearson, LPA
- Psychologist
- Jacksonville, NC
National Provider Identifier
1376521252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2269
- Practice address
- 1703 Country Club Rd
Suite 204
Jacksonville, NC 28546 - Phone
- (910) 347-3010
- Fax
- (910) 347-3201
- NPI assigned
- Jan 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2269 | NC | Primary |
Addresses
Primary practice location
1703 Country Club Rd
Suite 204
Jacksonville, NC 28546
Mailing address
1703 Country Club Rd
Suite 204
Jacksonville, NC 28546
Phone (910) 347-3010
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 141U1 | Other | NC | BC/BS |
| 6107133 | Medicaid | NC |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2269 | NC | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Resolutions Counseling and Mediation Services, PLLC | Past | Accepting new patients | |
| Carolina Psychological and Psychiatric Health SRVS, PA | Psychologist | Past | Accepting new patients |
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.
-
- Psychologist
- Jacksonville, NC
- NPI 1770561193
-
- Clinical Social Worker
- Jacksonville, NC
- NPI 1982868501
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210204800000",
"number": "1376521252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1703 COUNTRY CLUB RD",
"address_2": "SUITE 204",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "28546",
"telephone_number": "910-347-3010",
"fax_number": "910-347-3201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1703 COUNTRY CLUB RD",
"address_2": "SUITE 204",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "28546",
"telephone_number": "910-347-3010",
"fax_number": "910-347-3201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEARSON",
"first_name": "KENNETH",
"name_prefix": "Mr.",
"credential": "LPA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-03",
"last_updated": "2008-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "2269",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "141U1",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6107133",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.