Provider Demographics
NPI:1427527795
Name:PITTS, REBECCA L (MSN, FPMHNP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:L
Last Name:PITTS
Suffix:
Gender:F
Credentials:MSN, FPMHNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:L
Other - Last Name:RATLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3016 W CHARLESTON BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1964
Mailing Address - Country:US
Mailing Address - Phone:702-790-2701
Mailing Address - Fax:702-993-4005
Practice Address - Street 1:3016 W CHARLESTON BLVD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1964
Practice Address - Country:US
Practice Address - Phone:702-790-2701
Practice Address - Fax:702-993-4005
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019002643363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420065913Medicaid