Healthcare Provider Details

I. General information

NPI: 1104543545
Provider Name (Legal Business Name): WHITNEY B PRUITT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 U.S. 701, TABOR CITY, NC, 28463
TABOR CITY NC
28463-2846
US

IV. Provider business mailing address

11 E PINE CT
CAROLINA SHORES NC
28467-2641
US

V. Phone/Fax

Practice location:
  • Phone: 910-653-1901
  • Fax: 910-320-8435
Mailing address:
  • Phone: 910-393-7938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5017081
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: