Healthcare Provider Details

I. General information

NPI: 1952503690
Provider Name (Legal Business Name): EMILY J GARRETT-PRUETT RN, FNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15521 MIDLOTHIAN TPKE STE 105
MIDLOTHIAN VA
23113-7313
US

IV. Provider business mailing address

15521 MIDLOTHIAN TPKE STE 105
MIDLOTHIAN VA
23113-7313
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax:
Mailing address:
  • Phone: 804-207-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number124773
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number124773
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024193201
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: