Provider Demographics
NPI:1659467710
Name:PITKO, MARY JO (PA)
Entity Type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:PITKO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 A PROFESSIONAL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4303
Mailing Address - Country:US
Mailing Address - Phone:252-726-5767
Mailing Address - Fax:252-726-7573
Practice Address - Street 1:221A PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4303
Practice Address - Country:US
Practice Address - Phone:252-726-5767
Practice Address - Fax:252-726-7573
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102745363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical