MEDICARE: MRS. COURTNEY PITTMAN FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	R879673	MS
2	363L00000X	Nurse Practitioner	879673	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831440759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COURTNEY PITTMAN FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 2106
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39302-2106
Country	:	US
Telephone Number	:	601-703-3018
Fax Number	:	601-703-9283

Provider Business Practice Location Address
First Line	:	1500 HIGHWAY 19 N
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39307-5335
Country	:	US
Telephone Number	:	601-483-5353
Fax Number	:	601-482-1753

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2012
Last Update Date	:	10/05/2018

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