Provider Demographics
NPI:1639304835
Name:PITTS, ADDY (MHPP)
Entity Type:Individual
Prefix:
First Name:ADDY
Middle Name:
Last Name:PITTS
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:ADDY
Other - Middle Name:
Other - Last Name:RAMSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1415 S OSWEGO AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-2646
Mailing Address - Country:US
Mailing Address - Phone:479-967-3370
Mailing Address - Fax:479-967-2775
Practice Address - Street 1:1415 S OSWEGO AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-2646
Practice Address - Country:US
Practice Address - Phone:479-967-3370
Practice Address - Fax:479-967-2775
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator