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NPI Code Detail

MEDICARE: EMMA PRUETT FNP

MEDICARE: EMMA PRUETT 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
1363LF0000XFamily Nurse Practitioner1004304TX

General Provider Information

NPI Number : 1477193779
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMMA PRUETT FNP
Provider Business Mailing Address
First Line : 1018 N MOUND ST STE 202
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75961-4434
Country : US
Telephone Number : 936-568-8425
Fax Number :
Provider Business Practice Location Address
First Line : 1309 S UNIVERSITY DR
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75961-6486
Country : US
Telephone Number : 936-560-5668
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2020
Last Update Date : 04/02/2024

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