Provider Demographics
NPI:1316190929
Name:PRUITT, AMY NICOLE (ARNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:PRUITT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E ROBINSON ST
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6697
Mailing Address - Country:US
Mailing Address - Phone:405-360-1264
Mailing Address - Fax:
Practice Address - Street 1:500 E ROBINSON ST
Practice Address - Street 2:SUITE 2400
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6697
Practice Address - Country:US
Practice Address - Phone:405-360-1264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0073483363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner