Provider Demographics
NPI:1205422839
Name:PITTMAN, CODY BRUCE (MSN, APRN PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:BRUCE
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:MSN, APRN PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2901 HICKORY HILL CT
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-8666
Mailing Address - Country:US
Mailing Address - Phone:502-457-9475
Mailing Address - Fax:502-600-4373
Practice Address - Street 1:13050 MAGISTERIAL DR STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-5181
Practice Address - Country:US
Practice Address - Phone:502-457-9475
Practice Address - Fax:502-600-4373
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3015591363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health