Healthcare Provider Details

I. General information

NPI: 1275856114
Provider Name (Legal Business Name): JANIS AVEYARD PRUETT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANIS AVEYARD DEESE

II. Dates (important events)

Enumeration Date: 03/07/2010
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 WOODHURST PL
COPPELL TX
75019-3346
US

IV. Provider business mailing address

3604 RIDGELY AVENUE
LUBBOCK TX
79407-1118
US

V. Phone/Fax

Practice location:
  • Phone: 469-464-4001
  • Fax: 415-268-1179
Mailing address:
  • Phone: 214-532-6448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number585807
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP105787
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: