Provider Demographics
NPI:1023583606
Name:PITTS, KRISTAL SMITH
Entity type:Individual
Prefix:
First Name:KRISTAL
Middle Name:SMITH
Last Name:PITTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 OLD SHOALS JUNCTION RD
Mailing Address - Street 2:
Mailing Address - City:DONALDS
Mailing Address - State:SC
Mailing Address - Zip Code:29638-9648
Mailing Address - Country:US
Mailing Address - Phone:864-344-5495
Mailing Address - Fax:
Practice Address - Street 1:1304 SPRINGDALE DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7226
Practice Address - Country:US
Practice Address - Phone:864-833-6287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner