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NPI Code Detail

MEDICARE: JESSICA PRUITT

MEDICARE: JESSICA PRUITT
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
1163W00000XRegistered Nurse917225MS

General Provider Information

NPI Number : 1518813963
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA PRUITT
Provider Business Mailing Address
First Line : 217 ARNOLD DR
Second Line :
City : STARKVILLE
State : MS
Zip : 39759-6015
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 403 HOSPITAL RD
Second Line :
City : STARKVILLE
State : MS
Zip : 39759-2164
Country : US
Telephone Number : 662-615-1519
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2026
Last Update Date : 03/09/2026

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Directions to “ JESSICA PRUITT ” Practice Location

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