Basic Information
| Provider Information | |||||||||
| NPI: | 1669781332 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PITTS | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
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| Credential: | F.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9421 EASTSIDE DRIVE EXT | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393458063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016833001 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9421 EASTSIDE DRIVE EXT | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393458063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016832031 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2010 | ||||||||
| LastUpdateDate: | 09/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R801177 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 09015001 | 05 | MS | MEDICAID |