Healthcare Provider Details

I. General information

NPI: 1639304835
Provider Name (Legal Business Name): ADDY PITTS M.H.P.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADDY RAMSEY

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 05/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 S OSWEGO AVE
RUSSELLVILLE AR
72802-2646
US

IV. Provider business mailing address

1415 S OSWEGO AVE
RUSSELLVILLE AR
72802-2646
US

V. Phone/Fax

Practice location:
  • Phone: 479-967-3370
  • Fax: 479-967-2775
Mailing address:
  • Phone: 479-967-3370
  • Fax: 479-967-2775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: