Provider Demographics
NPI:1891188785
Name:PITTS, MARY JO (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:PITTS
Suffix:
Gender:F
Credentials:ARNP
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Mailing Address - Street 1:2406 WEST BROADWAY
Mailing Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL CENTER WEST BROADWAY, LLC
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211
Mailing Address - Country:US
Mailing Address - Phone:502-775-1211
Mailing Address - Fax:502-775-1221
Practice Address - Street 1:2406 WEST BROADWAY
Practice Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL CENTER WEST BROADWAY, LLC
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211
Practice Address - Country:US
Practice Address - Phone:502-775-1211
Practice Address - Fax:502-775-1221
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
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Provider Licenses
StateLicense IDTaxonomies
KY1124444163W00000X
KY3008334363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse