Healthcare Provider Details

I. General information

NPI: 1952765794
Provider Name (Legal Business Name): EMILY PITTS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5295 PRESERVE PKWY STE 210
HOOVER AL
35244-4702
US

IV. Provider business mailing address

5295 PRESERVE PKWY STE 210
HOOVER AL
35244-4702
US

V. Phone/Fax

Practice location:
  • Phone: 205-682-6077
  • Fax: 205-682-7646
Mailing address:
  • Phone: 205-682-6077
  • Fax: 205-682-7646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-130609
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: