Provider Demographics
NPI:1568946515
Name:PRATT, CAROL LEE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LEE
Last Name:PRATT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:LEE
Other - Last Name:MCGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:3098 OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-8938
Mailing Address - Country:US
Mailing Address - Phone:573-778-2600
Mailing Address - Fax:
Practice Address - Street 1:3098 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-8938
Practice Address - Country:US
Practice Address - Phone:573-778-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018025994363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner