1114902277 NPI number — MRS. DEBORAH WHITMIRE PITTILLO FNP

Table of content: MERCY DEANDA (NPI 1508460114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114902277 NPI number — MRS. DEBORAH WHITMIRE PITTILLO FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PITTILLO
Provider First Name:
DEBORAH
Provider Middle Name:
WHITMIRE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114902277
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27877
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84127-0877
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-694-8350
Provider Business Mailing Address Fax Number:
828-694-7654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2695 HENDERSONVILLE RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARDEN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28704-8576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-684-6035
Provider Business Practice Location Address Fax Number:
828-654-8152
Provider Enumeration Date:
12/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  201649 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 611186890 . This is a "PRIVATE HEALTHCARE SAVING" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611186890 . This is a "BEECH STREET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 500030491 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611186890 . This is a "HUMANA TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611186890 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: C0039 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: NCX355A . This is a "MEDICARE PTAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0171701 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: O12U9 . This is a "BCBS NC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7000364 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NP0683 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 611186890 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611186890 . This is a "HEALTHCARE SAVINGS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611186890 . This is a "CRESENT" identifier . This identifiers is of the category "OTHER".




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