Basic Information
| Provider Information | |||||||||
| NPI: | 1407256217 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FITTS | ||||||||
| FirstName: | PINKIE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 SUN TEMPLE DR | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357588643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2569754291 | ||||||||
| FaxNumber: | 2562883334 | ||||||||
| Practice Location | |||||||||
| Address1: | 1040 LONGFIELD CT | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361178055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342889009 | ||||||||
| FaxNumber: | 3342889497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2014 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1-092041 | AL | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 1-092041 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1-092041 | 01 | AL | AL BOARD OF NURSING LICENSE | OTHER |