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General NPI Number Information
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NPI Number | 1710447461
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Entity Type | Individual
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Provider Name | RACHEL PRUETT
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Gender | Female
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Dates
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Enumeration Date | 03/20/2019
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 1500 N OAKLAND AVE
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City | BOLIVAR
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State | MO
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Zip | 65613-3099
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Country | US
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Telephone | 471-326-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 633 E LINDON ST
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City | BOLIVAR
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State | MO
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Zip | 65613-1231
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Country | US
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Telephone | 870-715-9853
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2024023331
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License Number State | MO
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