Healthcare Provider Details

I. General information

NPI: 1497702096
Provider Name (Legal Business Name): MELISSA D PRUITT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA D PRUITT MD

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 SPRINGHILL DR
NORTH LITTLE ROCK AR
72117
US

IV. Provider business mailing address

404 W SCENIC DR
NORTH LITTLE ROCK AR
72118-5152
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-3802
  • Fax:
Mailing address:
  • Phone: 901-412-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-14973
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-14973
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE14973
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE14972
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: