Provider Demographics
NPI:1871578344
Name:PITTS, JEANETTE M (MD)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:M
Last Name:PITTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 SW 6TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1707
Mailing Address - Country:US
Mailing Address - Phone:785-354-8518
Mailing Address - Fax:785-354-1255
Practice Address - Street 1:5820 LAMAR AVE STE 200
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-2655
Practice Address - Country:US
Practice Address - Phone:913-631-6330
Practice Address - Fax:913-631-6222
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-52129207ND0101X
TXU1353207ND0101X
AZ30913207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ737265Medicaid
AZ86080015085259C301OtherTRIWEST
AZ070017561OtherRAILROAD MEDICARE
AZ86080015085259C301OtherTRIWEST
AZ737265Medicaid