Provider Demographics
NPI:1497300362
Name:PILLITTERI, THOMAS (APRN)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:PILLITTERI
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 SOUTHERN PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-1356
Mailing Address - Country:US
Mailing Address - Phone:502-523-6195
Mailing Address - Fax:
Practice Address - Street 1:3021 LONG CREEK WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5306
Practice Address - Country:US
Practice Address - Phone:502-609-2708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1132294163W00000X
KY3013563363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse