Provider Demographics
NPI:1649731688
Name:PITTS, TAYLOR BILBO (NP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:BILBO
Last Name:PITTS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:ANN
Other - Last Name:BILBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7373 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8585 PICARDY AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3748
Practice Address - Country:US
Practice Address - Phone:225-763-4212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-30
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203623363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2493876Medicaid