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NPI Code Detail

MEDICARE: ADAM PRUETT RDN

MEDICARE: ADAM PRUETT RDN
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
1133V00000XRegistered Dietitian2008029468MO
2133V00000XRegistered Dietitian164.007263IL

General Provider Information

NPI Number : 1386140614
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADAM PRUETT RDN
Provider Business Mailing Address
First Line : 5116 EAGLE WING CT
Second Line :
City : EUREKA
State : MO
Zip : 63025-4043
Country : US
Telephone Number : 636-584-9153
Fax Number :
Provider Business Practice Location Address
First Line : 5900 BOND AVE
Second Line :
City : EAST SAINT LOUIS
State : IL
Zip : 62207-2326
Country : US
Telephone Number : 618-332-5458
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2018
Last Update Date : 04/04/2018

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Directions to “ ADAM PRUETT RDN” Practice Location

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