Provider Demographics
NPI:1093428997
Name:PRUIT, KAITLIN LEIGH (CNS, APRN, RN)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:LEIGH
Last Name:PRUIT
Suffix:
Gender:F
Credentials:CNS, APRN, RN
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:LEIGH
Other - Last Name:FLEISCHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS, APRN, RN
Mailing Address - Street 1:288 JACKALBERRY ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-6318
Mailing Address - Country:US
Mailing Address - Phone:916-204-8428
Mailing Address - Fax:
Practice Address - Street 1:288 JACKALBERRY ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-6318
Practice Address - Country:US
Practice Address - Phone:916-204-8428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135010364SM0705X
NV847635364SM0705X, 163W00000X
CA841778163W00000X
IL041398838163W00000X
TX915210163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
No163W00000XNursing Service ProvidersRegistered Nurse