Healthcare Provider Details

I. General information

NPI: 1932598646
Provider Name (Legal Business Name): MEGAN REA PITTMAN APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2015
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S LINDELL ST
MARTIN TN
38237-2442
US

IV. Provider business mailing address

25 ALDERBROOK LN
JACKSON TN
38305-1882
US

V. Phone/Fax

Practice location:
  • Phone: 731-281-4292
  • Fax:
Mailing address:
  • Phone: 731-313-1986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19591
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: