Healthcare Provider Details

I. General information

NPI: 1205756590
Provider Name (Legal Business Name): YAKHARI K PRUITT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 EVERGREEN PL
PETAL MS
39465-9439
US

IV. Provider business mailing address

30 EVERGREEN PL
PETAL MS
39465-9439
US

V. Phone/Fax

Practice location:
  • Phone: 601-325-1504
  • Fax:
Mailing address:
  • Phone: 601-325-1504
  • Fax: 601-325-1504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: