Provider Demographics
NPI:1235600487
Name:PRUITT, FRANCES KAY (CNA)
Entity Type:Individual
Prefix:
First Name:FRANCES
Middle Name:KAY
Last Name:PRUITT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SHADY GROVE DR APT C
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-7590
Mailing Address - Country:US
Mailing Address - Phone:817-559-4769
Mailing Address - Fax:
Practice Address - Street 1:119 WOODSTREAM CT
Practice Address - Street 2:
Practice Address - City:CRESSON
Practice Address - State:TX
Practice Address - Zip Code:76035-5681
Practice Address - Country:US
Practice Address - Phone:817-296-3877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA8460583376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5GR5-V62-CV40OtherPART A AND PART B MEDICARE