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General NPI Number Information
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NPI Number | 1295738706
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Entity Type | Individual
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Provider Name | TIMOTHY MICHAEL PRUITT DNP
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Gender | Male
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Dates
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Enumeration Date | 05/30/2005
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 7601 SOUTHCREST PKWY
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City | SOUTHAVEN
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State | MS
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Zip | 38671
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Country | US
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Telephone | 662-772-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 5381 ALLEN RD
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City | HERNANDO
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State | MS
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Zip | 38632-9608
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Country | US
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Telephone | 502-810-4146
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN298030
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | A001384
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 19099
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | RN298030
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | A001384
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License Number State | AR
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Taxonomy #6
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 19099
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License Number State | TN
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Taxonomy #7
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 893878
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License Number State | MS
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Taxonomy #8
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN298030
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License Number State | GA
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Taxonomy #9
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 893878
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License Number State | MS
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