Healthcare Provider Details

I. General information

NPI: 1255571980
Provider Name (Legal Business Name): RAVA PITTMAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 KATHERINE DR STE A
FLOWOOD MS
39232-9588
US

IV. Provider business mailing address

201A MAGNOLIA ST POST OFFICE BOX 369
VAIDEN MS
39176-5644
US

V. Phone/Fax

Practice location:
  • Phone: 601-665-4162
  • Fax: 855-830-3484
Mailing address:
  • Phone: 662-464-5470
  • Fax: 662-464-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number866334
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: