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General NPI Number Information
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NPI Number | 1316413255
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Entity Type | Individual
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Provider Name | LORI GAYLE PRUITT FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/18/2018
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Last Update Date | 10/18/2018
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Provider Practice Location Address
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Address Line | 575 HILL COUNTRY DR
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City | KERRVILLE
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State | TX
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Zip | 78028-6024
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Country | US
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Telephone | 830-258-7762
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Fax |
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Provider Business Mailing Address
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Address Line | 170 MACKAY DR
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City | KERRVILLE
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State | TX
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Zip | 78028-8428
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Country | US
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Telephone | 830-285-0929
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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 | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | 664299
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP1139202
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License Number State | TX
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