Provider Demographics
NPI:1891990479
Name:PITTMAN, JERYL LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:JERYL
Middle Name:LYNN
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3190 IRVINE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-9031
Mailing Address - Country:US
Mailing Address - Phone:859-369-7099
Mailing Address - Fax:859-369-0073
Practice Address - Street 1:3190 IRVINE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-9031
Practice Address - Country:US
Practice Address - Phone:859-369-7099
Practice Address - Fax:859-369-0073
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3003278363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care