Healthcare Provider Details

I. General information

NPI: 1598775843
Provider Name (Legal Business Name): MITZI G PRUITT RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 AIRPORT RD SUITE B
HOT SPRINGS AR
71913-7951
US

IV. Provider business mailing address

1661 AIRPORT RD SUITE D
HOT SPRINGS AR
71913-7951
US

V. Phone/Fax

Practice location:
  • Phone: 501-767-0075
  • Fax: 501-767-2739
Mailing address:
  • Phone: 501-625-7500
  • Fax: 501-625-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberP01193
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: