Mary Amanda Amanda Pittman

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

277002173 Issued in IL

Practice address

Student Success Center Room 0222
Edwardsville, IL 62026-1166

Phone

(618) 650-2842

Fax

(618) 650-5839

NPI assigned

Mar 22, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: marypittman@macoupinfm.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Board of Trustees of Siu Governing Siue

  • Student Health Clinic/Center
  • Edwardsville, IL
  • NPI 1932441946
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1609238518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7503 S RIDGE CT",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620626442",
            "telephone_number": "618-841-8767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "STUDENT SUCCESS CENTER ROOM 0222",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620261166",
            "telephone_number": "618-650-2842",
            "fax_number": "618-650-5839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PITTMAN",
        "first_name": "MARY AMANDA",
        "middle_name": "AMANDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-22",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "277002173",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277002173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDFPR",
            "identifier": "277002173",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": ".",
            "affiliation": "N",
            "address_1": "Student Success Center Room 0222",
            "city": "Edwardsville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620261166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Taylor Jean Petrunich, IBCLC
• Shawnna M Phillips, RN
• Laci Pigg, BT
• Ariana Pinon
• Holly Pirtle, LCPC
• Erika Lynn Pogue, RN
• Anna Poirier, RN
• Jordan Ponce, PT, DPT
• Kelli Powe, BEHAVIOR TECHNICIAN
• Dakeisha Powers

• Family Nurse Practitioner in Edwardsville, IL
• Providers in Edwardsville, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.