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Individual

LUCAS TYLER PITTMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT

Contact information

Practice address
340 N CEDAR AVE, COOKEVILLE, TN 38501-2421
(931) 783-5353
Mailing address
140 W 7TH ST, COOKEVILLE, TN 38501-1726
(931) 783-5582

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4428
TN
363AM0700X
Medical Physician Assistant
4428
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
Q063825
TN
Enumeration date
01/21/2021
Last updated
10/25/2023
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