Olean Denise Pittman
Individual provider Active NPI Homemaker · Mathiston, MS
NPI 1104533348 · NPPES record last updated Apr 10, 2023
Key facts
- NPI
- 1104533348
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Homemaker 376J00000X
- License
- 002482 (MS)
- Practice address
- 24224 Ms Highway 15
Mathiston, MS 39752-6876 - Phone
- (662) 263-3194
- NPI assigned
- Oct 27, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002482 | MS | MD | Homemaker |
| 3996 | MS | MD | Homemaker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grace & Mercy Personal Care Provider LLC | Home Health | Current |
Accepting new patients |
Locations
63 Gwenn Ray Dr
Eupora, MS 39744
Phone (662) 258-1018
24224 MS Highway 15
Mathiston, MS 39752
Phone (662) 263-3194
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 002482 | MS | |
| Homemaker | 376J00000X | 3996 | MS | |
| Homemaker | 376J00000X | 002482 | MS | Yes |
Addresses
Primary practice location
24224 Ms Highway 15
Mathiston, MS 39752-6876
Mailing address
24224 Ms Highway 15
Mathiston, MS 39752-6876
Phone (662) 263-3194
Other providers in Mathiston, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 10, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.