Provider Demographics
NPI:1356198022
Name:PITTMAN, KIMBERLIN DIANE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KIMBERLIN
Middle Name:DIANE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 MANHATTAN BLVD STE J
Mailing Address - Street 2:# 306
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058
Mailing Address - Country:US
Mailing Address - Phone:504-388-4680
Mailing Address - Fax:
Practice Address - Street 1:1801 MANHATTAN BLVD STE J
Practice Address - Street 2:# 306
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058
Practice Address - Country:US
Practice Address - Phone:504-388-4680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA234891363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health