Healthcare Provider Details

I. General information

NPI: 1093428997
Provider Name (Legal Business Name): KAITLIN LEIGH PRUIT CNS, APRN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLIN LEIGH FLEISCHMAN CNS, APRN, RN

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 JACKALBERRY ST
LAS VEGAS NV
89138-6318
US

IV. Provider business mailing address

288 JACKALBERRY ST
LAS VEGAS NV
89138-6318
US

V. Phone/Fax

Practice location:
  • Phone: 916-204-8428
  • Fax:
Mailing address:
  • Phone: 916-204-8428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberAP135010
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number847635
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number841778
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041398838
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number847635
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number915210
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: