Provider Demographics
NPI:1508117573
Name:PRUETT, ANNA KATE (PA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:KATE
Last Name:PRUETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 AVIEMORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9700
Mailing Address - Country:US
Mailing Address - Phone:910-215-5555
Mailing Address - Fax:910-215-0366
Practice Address - Street 1:10 AVIEMORE DRIVE
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9700
Practice Address - Country:US
Practice Address - Phone:910-215-5555
Practice Address - Fax:910-215-0366
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-03671363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant