Provider Demographics
NPI:1083273825
Name:PRUETT, CATHERN AMANDA (NP)
Entity Type:Individual
Prefix:
First Name:CATHERN
Middle Name:AMANDA
Last Name:PRUETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 25TH ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-5000
Mailing Address - Country:US
Mailing Address - Phone:812-277-0118
Mailing Address - Fax:812-277-0127
Practice Address - Street 1:1614 25TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-5000
Practice Address - Country:US
Practice Address - Phone:812-277-0118
Practice Address - Fax:812-277-0127
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28185398A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics