Provider Demographics
NPI:1073943155
Name:PITTMAN, KIMBERLY (PMHNPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:PMHNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5906 SAXON DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-6241
Mailing Address - Country:US
Mailing Address - Phone:409-457-1413
Mailing Address - Fax:
Practice Address - Street 1:3533 TOWN CENTER BLVD S
Practice Address - Street 2:SUITE 300
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1454
Practice Address - Country:US
Practice Address - Phone:281-313-4666
Practice Address - Fax:281-566-1159
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124211363LP0808X
NC5014161363LP0808X
TX788112164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP124211OtherPMHNPC
TX788112OtherNURSING LICENSE