Healthcare Provider Details

I. General information

NPI: 1639587579
Provider Name (Legal Business Name): JULIE CHRISTINE PRUETT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 SAN DIMAS ST
BAKERSFIELD CA
93301-5731
US

IV. Provider business mailing address

PO BOX 1139
BAKERSFIELD CA
93302-1139
US

V. Phone/Fax

Practice location:
  • Phone: 661-323-8477
  • Fax: 661-323-8472
Mailing address:
  • Phone: 661-371-2796
  • Fax: 661-438-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP11945
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: