Healthcare Provider Details

I. General information

NPI: 1871578344
Provider Name (Legal Business Name): JEANETTE M PITTS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 LAMAR AVE STE 200
MISSION KS
66202-2655
US

IV. Provider business mailing address

2200 SW 6TH AVE STE 104
TOPEKA KS
66606-1707
US

V. Phone/Fax

Practice location:
  • Phone: 913-631-6330
  • Fax: 913-631-6222
Mailing address:
  • Phone: 785-354-8518
  • Fax: 785-354-1255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number30913
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number04-52129
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberU1353
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: