Provider Demographics
NPI:1669781332
Name:PITTS, ELIZABETH (FNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:PITTS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9421 EASTSIDE DRIVE EXT
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MS
Mailing Address - Zip Code:39345-8063
Mailing Address - Country:US
Mailing Address - Phone:601-683-3001
Mailing Address - Fax:
Practice Address - Street 1:9421 EASTSIDE DRIVE EXT
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345-8063
Practice Address - Country:US
Practice Address - Phone:601-683-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR801177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015001Medicaid