=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336002625
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLERIM CLINIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2025
-----------------------------------------------------
Last Update Date | 12/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 DOCTORS PARK
-----------------------------------------------------
City | GALAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24333-2277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-806-6179
-----------------------------------------------------
Fax | 866-487-8351
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3713 CHERRYLOG RD
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37921-1412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-806-6179
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FNP
-----------------------------------------------------
Name | MARK PRUITT
-----------------------------------------------------
Credential | MSN
-----------------------------------------------------
Telephone | 865-806-6179
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------