Provider Demographics
NPI:1376973248
Name:PRUITT, SHERRIE HOLLAND (RDH , IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:SHERRIE
Middle Name:HOLLAND
Last Name:PRUITT
Suffix:
Gender:F
Credentials:RDH , IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-6318
Mailing Address - Country:US
Mailing Address - Phone:615-230-6611
Mailing Address - Fax:615-230-6614
Practice Address - Street 1:615 COMMONS DR
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6318
Practice Address - Country:US
Practice Address - Phone:615-230-6611
Practice Address - Fax:615-230-6614
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2021-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
TN3985124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No124Q00000XDental ProvidersDental Hygienist