Provider Demographics
NPI:1871058255
Name:PITTMAN, JEFFREY W SR (NRCPT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:W
Last Name:PITTMAN
Suffix:SR
Gender:M
Credentials:NRCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4516 E 48TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64130-2231
Mailing Address - Country:US
Mailing Address - Phone:816-705-7308
Mailing Address - Fax:
Practice Address - Street 1:4516 E 48TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64130-2231
Practice Address - Country:US
Practice Address - Phone:816-304-6845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-09
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS136505246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program