Provider Demographics
NPI:1699537902
Name:PITTS, TARA NICHOLE (MPAS, PA-C)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:NICHOLE
Last Name:PITTS
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:KEO
Mailing Address - State:AR
Mailing Address - Zip Code:72083-0022
Mailing Address - Country:US
Mailing Address - Phone:501-590-3470
Mailing Address - Fax:
Practice Address - Street 1:500 S UNIVERSITY AVE STE 505
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5307
Practice Address - Country:US
Practice Address - Phone:501-588-1100
Practice Address - Fax:501-588-1750
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
ARPA1254363A00000X
AR363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant