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NPI Code Detail

MEDICARE: MARK A PRUITT FNP

MEDICARE: MARK A PRUITT FNP
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
1363L00000XNurse Practitioner7012TN
2363L00000XNurse Practitioner0024178316VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437144938
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK A PRUITT FNP
Provider Business Mailing Address
First Line : 101 DOCTORS PARK
Second Line :
City : GALAX
State : VA
Zip : 24333-2277
Country : US
Telephone Number : 276-595-8921
Fax Number : 276-883-6232
Provider Business Practice Location Address
First Line : 101 DOCTORS PARK
Second Line :
City : GALAX
State : VA
Zip : 24333-2277
Country : US
Telephone Number : 541-632-4050
Fax Number : 276-883-6232
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2005
Last Update Date : 06/09/2026

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Directions to “ MARK A PRUITT FNP” Practice Location

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