MEDICARE: PRUVEN HEALTH

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
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1649758038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRUVEN HEALTH

Provider Business Mailing Address
First Line	:	4841 KELLER SPRINGS RD
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-5912
Country	:	US
Telephone Number	:	605-484-8803
Fax Number	:	214-261-5155

Provider Business Practice Location Address
First Line	:	4841 KELLER SPRINGS RD
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-5912
Country	:	US
Telephone Number	:	469-848-7376
Fax Number	:	214-261-5155

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. RONNA BROOKS
Credential	:
Telephone Number	:	214-310-9888

Provider Enumeration Date	:	07/30/2018
Last Update Date	:	06/08/2023

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Directions to “PRUVEN HEALTH ” Practice Location

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