Provider Demographics
NPI:1164190062
Name:PITTS, KESHAWNA MARIE (MSN,RN,APRN,PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KESHAWNA
Middle Name:MARIE
Last Name:PITTS
Suffix:
Gender:F
Credentials:MSN,RN,APRN,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-4463
Mailing Address - Country:US
Mailing Address - Phone:193-751-4416
Mailing Address - Fax:
Practice Address - Street 1:2022 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-4463
Practice Address - Country:US
Practice Address - Phone:193-751-4416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0029648363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health