Provider Demographics
NPI:1306055215
Name:PITTMAN, KELVIN ANDRE
Entity type:Individual
Prefix:MR
First Name:KELVIN
Middle Name:ANDRE
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3926 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1151
Mailing Address - Country:US
Mailing Address - Phone:971-344-6843
Mailing Address - Fax:
Practice Address - Street 1:2130 SW 5TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-4976
Practice Address - Country:US
Practice Address - Phone:503-963-7765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion