Provider Demographics
NPI:1548555253
Name:PITTMAN, LAURA OLIVIA (NP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:OLIVIA
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:OLIVIA
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:9160 CORTIM CIR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-1124
Mailing Address - Country:US
Mailing Address - Phone:409-238-1715
Mailing Address - Fax:409-330-4809
Practice Address - Street 1:6000 39TH ST
Practice Address - Street 2:
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619-4600
Practice Address - Country:US
Practice Address - Phone:409-962-8509
Practice Address - Fax:409-962-0763
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120395363LF0000X
TX716867363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX359504301Medicaid
TX460492ZQ70Medicare UPIN