Provider Demographics
NPI:1902168982
Name:PITTMAN, KIMBERLI VONKEY
Entity Type:Individual
Prefix:
First Name:KIMBERLI
Middle Name:VONKEY
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3493 SE JAKE CT APT 98
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-5057
Mailing Address - Country:US
Mailing Address - Phone:772-985-2018
Mailing Address - Fax:
Practice Address - Street 1:15818 SW WARFIELD BLVD
Practice Address - Street 2:
Practice Address - City:INDIANTOWN
Practice Address - State:FL
Practice Address - Zip Code:34956-3513
Practice Address - Country:US
Practice Address - Phone:772-597-0411
Practice Address - Fax:772-597-0412
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator