Provider Demographics
NPI:1164836136
Name:PITTS, MELISSA LYNN (MN-FNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:PITTS
Suffix:
Gender:F
Credentials:MN-FNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LYNN GILMORE
Other - Last Name:PITTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 CHARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452-3701
Mailing Address - Country:US
Mailing Address - Phone:985-960-3634
Mailing Address - Fax:985-888-1838
Practice Address - Street 1:141 LAKEVIEW CIR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7513
Practice Address - Country:US
Practice Address - Phone:985-231-6751
Practice Address - Fax:985-888-1838
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07833363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care