1194164376 NPI number — MS. TAMMY YVETTE PITTS MS

Table of content: MS. TAMMY YVETTE PITTS MS (NPI 1194164376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194164376 NPI number — MS. TAMMY YVETTE PITTS MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PITTS
Provider First Name:
TAMMY
Provider Middle Name:
YVETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS
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:
1194164376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 W 17TH ST APT 210
Provider Second Line Business Mailing Address:
1860 EAST 15TH. STREET TULSA, OK 74104
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74119-4649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-949-4430
Provider Business Mailing Address Fax Number:
918-949-4431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1860 EAST 15TH. STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-949-4430
Provider Business Practice Location Address Fax Number:
918-949-4431
Provider Enumeration Date:
06/20/2013

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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