Provider Demographics
NPI:1467729293
Name:PITTS, KAREN RENEE (FNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:RENEE
Last Name:PITTS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-268-5700
Mailing Address - Fax:601-268-5777
Practice Address - Street 1:415 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7246
Practice Address - Country:US
Practice Address - Phone:601-268-5700
Practice Address - Fax:601-268-5777
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR859502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05628370Medicaid
MS5979661OtherCIGNA
MS9798787OtherAETNA
MSP01087222OtherRAILROAD MEDICARE
MS05628370Medicaid