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General NPI Number Information
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NPI Number | 1235296146
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Entity Type | Organization
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Legal Business Name | GLENDA PRUITT PC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 119 CENTRAL AVE. 119 CENTRAL AVE.
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City | STRAWN
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State | TX
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Zip | 76475-0006
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Country | US
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Telephone | 254-672-5200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6 119 CENTRAL AVE.
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City | STRAWN
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State | TX
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Zip | 76475-0006
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Country | US
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Telephone | 254-672-5200
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. GLENDA F. PRUITT
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Credential | RN CFNP
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Telephone | 254-672-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 220196
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License Number State | TX
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