Healthcare Provider Details

I. General information

NPI: 1043702863
Provider Name (Legal Business Name): JENNIFER A PITTS CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N LORRAINE ST STE 202
HUTCHINSON KS
67501
US

IV. Provider business mailing address

1600 N LORRAINE ST STE 202
HUTCHINSON KS
67501-5600
US

V. Phone/Fax

Practice location:
  • Phone: 620-663-7595
  • Fax: 620-728-2031
Mailing address:
  • Phone: 620-663-7595
  • Fax: 620-728-2031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number22925
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: