Healthcare Provider Details

I. General information

NPI: 1497896724
Provider Name (Legal Business Name): LAURA A. TRUITT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 YALOBUSHA ST
GREENWOOD MS
38930-2015
US

IV. Provider business mailing address

PO BOX 62
CARROLLTON MS
38917-0062
US

V. Phone/Fax

Practice location:
  • Phone: 662-453-4563
  • Fax:
Mailing address:
  • Phone: 662-237-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR506575
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: