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General NPI Number Information
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NPI Number | 1285049254
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Entity Type | Individual
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Provider Name | KELLI ELIZABETH PRUITT
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Gender | Female
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Dates
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Enumeration Date | 06/27/2014
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 2969 CURRAN DR N
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City | JACKSON
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State | MS
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Zip | 39216-4121
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Country | US
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Telephone | 601-540-5598
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Fax |
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Provider Business Mailing Address
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Address Line | 2969 CURRAN DR N
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City | JACKSON
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State | MS
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Zip | 39216-4121
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Country | US
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Telephone | 601-540-5598
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11007306
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11007306
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R883741
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP61401686
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10006919
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License Number State | OR
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R883741
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License Number State | MS
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