Healthcare Provider Details

I. General information

NPI: 1487145215
Provider Name (Legal Business Name): LUCAS PITTMAN APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 STATE ST
WASHINGTON IN
47501
US

IV. Provider business mailing address

515 BAYOU ST
VINCENNES IN
47591-1034
US

V. Phone/Fax

Practice location:
  • Phone: 812-254-1558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008078A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71008078A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: