Healthcare Provider Details

I. General information

NPI: 1316413255
Provider Name (Legal Business Name): LORI GAYLE PRUITT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 HILL COUNTRY DR
KERRVILLE TX
78028-6024
US

IV. Provider business mailing address

170 MACKAY DR
KERRVILLE TX
78028-8428
US

V. Phone/Fax

Practice location:
  • Phone: 830-258-7762
  • Fax:
Mailing address:
  • Phone: 830-285-0929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number664299
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP1139202
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: