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General NPI Number Information
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NPI Number | 1174449961
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Entity Type | Individual
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Provider Name | MICAH PRUETT RN
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Gender | Female
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Dates
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Enumeration Date | 06/25/2026
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Last Update Date | 06/25/2026
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Provider Practice Location Address
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Address Line | 3601 CCI DR NW
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City | HUNTSVILLE
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State | AL
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Zip | 35805-2606
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Country | US
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Telephone | 256-705-4224
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Fax |
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Provider Business Mailing Address
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Address Line | 478 WADE RD SE
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City | OWENS CROSS ROADS
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State | AL
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Zip | 35763-9128
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Country | US
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Telephone | 256-714-7008
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1-199172
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License Number State | AL
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