Provider Demographics
NPI:1639587579
Name:PRUETT, JULIE CHRISTINE (FNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:CHRISTINE
Last Name:PRUETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1139
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1139
Mailing Address - Country:US
Mailing Address - Phone:661-371-2796
Mailing Address - Fax:661-438-1746
Practice Address - Street 1:3801 SAN DIMAS ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5731
Practice Address - Country:US
Practice Address - Phone:661-323-8477
Practice Address - Fax:661-323-8472
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP11945363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily