Individual
STACY PEARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
900 42ND ST S, FARGO, ND 58103-2119
(701) 238-5652
Mailing address
900 42ND ST S, FARGO, ND 58103-2119
(701) 238-5652
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
—
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07111972
—
ND
Enumeration date
11/20/2019
Last updated
11/20/2019
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