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General NPI Number Information
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NPI Number | 1205422839
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Entity Type | Individual
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Provider Name | CODY BRUCE PITTMAN MSN, APRN. PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 12/17/2020
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 13050 MAGISTERIAL DR STE 100
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City | LOUISVILLE
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State | KY
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Zip | 40223-5181
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Country | US
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Telephone | 502-225-3299
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Fax | 502-600-4373
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Provider Business Mailing Address
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Address Line | 2901 HICKORY HILL CT
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City | LA GRANGE
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State | KY
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Zip | 40031-8666
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Country | US
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Telephone | 502-225-3299
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Fax | 502-600-4373
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 3015591
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License Number State | KY
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