Healthcare Provider Details

I. General information

NPI: 1689982837
Provider Name (Legal Business Name): TEARA FANAY PITTS P.C.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 HIGHWAY 52 BYP E
LAFAYETTE TN
37083-1009
US

IV. Provider business mailing address

601 HIGHWAY 52 BYP E
LAFAYETTE TN
37083-1009
US

V. Phone/Fax

Practice location:
  • Phone: 615-666-2142
  • Fax: 615-666-6153
Mailing address:
  • Phone: 615-666-2142
  • Fax: 615-666-6153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number00133529
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: