Provider Demographics
NPI:1518047935
Name:PITTS, KATHLEEN (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PITTS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:PITTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, CPNP, NNP, MPH
Mailing Address - Street 1:1102 BATES AVE
Mailing Address - Street 2:FC-330
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2617
Mailing Address - Country:US
Mailing Address - Phone:832-824-1319
Mailing Address - Fax:832-825-1260
Practice Address - Street 1:6701 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2316
Practice Address - Country:US
Practice Address - Phone:832-822-3245
Practice Address - Fax:832-825-3251
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX598676363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137845705Medicaid
TX88G300Medicare PIN
B77046Medicare UPIN
TX137845705Medicaid