Healthcare Provider Details

I. General information

NPI: 1205422839
Provider Name (Legal Business Name): CODY BRUCE PITTMAN MSN, APRN. PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13050 MAGISTERIAL DR STE 100
LOUISVILLE KY
40223-5181
US

IV. Provider business mailing address

2901 HICKORY HILL CT
LA GRANGE KY
40031-8666
US

V. Phone/Fax

Practice location:
  • Phone: 502-225-3299
  • Fax: 502-600-4373
Mailing address:
  • Phone: 502-225-3299
  • Fax: 502-600-4373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3015591
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: