Provider Demographics
NPI:1275841199
Name:PRUITT, MARY ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:PRUITT
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:833 BUFFALO ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-1111
Mailing Address - Country:US
Mailing Address - Phone:434-392-8177
Mailing Address - Fax:434-392-8287
Practice Address - Street 1:833 BUFFALO ST STE 200
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1111
Practice Address - Country:US
Practice Address - Phone:434-392-8177
Practice Address - Fax:434-392-8287
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024167714363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily