Provider Demographics
NPI:1922032291
Name:PITTS, CAROL ANN (RD, LN)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:PITTS
Suffix:
Gender:F
Credentials:RD, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2153
Mailing Address - Country:US
Mailing Address - Phone:605-692-4507
Mailing Address - Fax:309-406-0985
Practice Address - Street 1:911 ST.JOHN
Practice Address - Street 2:
Practice Address - City:FAULKTON
Practice Address - State:SD
Practice Address - Zip Code:57438-0100
Practice Address - Country:US
Practice Address - Phone:605-598-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0139133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered