Provider Demographics
NPI:1770866246
Name:PITMAN, ANGELA RAYLEEN (ACNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RAYLEEN
Last Name:PITMAN
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-0014
Mailing Address - Country:US
Mailing Address - Phone:615-322-3384
Mailing Address - Fax:615-322-7886
Practice Address - Street 1:1215 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0014
Practice Address - Country:US
Practice Address - Phone:615-322-3384
Practice Address - Fax:615-322-7886
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007166363LA2100X
TN0000178625363LA2100X
TN18375363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00994984OtherRAILROAD MEDICARE
KY000000738633OtherBCBS-TROVER CLINIC FOUNDATION INC
KY7100181910Medicaid
KY7100181910Medicaid