Provider Demographics
NPI:1770556318
Name:PITTMAN, LAURA THOMPSON (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:THOMPSON
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0640
Mailing Address - Country:US
Mailing Address - Phone:252-536-5440
Mailing Address - Fax:252-536-5444
Practice Address - Street 1:250 SMITH CHURCH RD
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4914
Practice Address - Country:US
Practice Address - Phone:252-535-8424
Practice Address - Fax:252-535-8847
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200651363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005319Medicaid
NC1606WOtherBCBS OF NC
NCP01096320OtherRAILROAD MEDICARE
NC7005319Medicaid
NCP18744Medicare UPIN