Provider Demographics
NPI:1275856114
Name:PRUETT, JANIS AVEYARD (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:AVEYARD
Last Name:PRUETT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JANIS
Other - Middle Name:AVEYARD
Other - Last Name:DEESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 WOODHURST PL
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-3346
Mailing Address - Country:US
Mailing Address - Phone:469-464-4001
Mailing Address - Fax:415-268-1179
Practice Address - Street 1:325 WOODHURST PL
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-3346
Practice Address - Country:US
Practice Address - Phone:469-464-4001
Practice Address - Fax:415-268-1179
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-07
Last Update Date:2010-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX585807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily