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NPI Code Detail

MEDICARE: MELISSA PRUITT FNP-C

MEDICARE: MELISSA PRUITT FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAPRN-NP191680GA

General Provider Information

NPI Number : 1295392975
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA PRUITT FNP-C
Provider Business Mailing Address
First Line : 17 WHITE ST
Second Line :
City : CLEVELAND
State : GA
Zip : 30528-1140
Country : US
Telephone Number : 706-969-7510
Fax Number :
Provider Business Practice Location Address
First Line : 17 WHITE ST
Second Line :
City : CLEVELAND
State : GA
Zip : 30528-1140
Country : US
Telephone Number : 706-969-7510
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2019
Last Update Date : 10/16/2025

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