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General NPI Number Information
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NPI Number | 1053644070
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Entity Type | Individual
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Provider Name | KIMBERLEY LAYNE BENTON PRUITT PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 09/09/2009
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 8506 SIX FORKS RD STE 104
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City | RALEIGH
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State | NC
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Zip | 27615-3260
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Country | US
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Telephone | 919-234-7247
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Fax | 919-238-1970
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Provider Business Mailing Address
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Address Line | 8506 SIX FORKS RD STE 104
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City | RALEIGH
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State | NC
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Zip | 27615-3260
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Country | US
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Telephone | 919-234-7247
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Fax | 919-238-1970
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5077
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License Number State | NC
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