Provider Demographics
NPI:1801364021
Name:PRUITT, TONIA
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:
Last Name:PRUITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TONIA
Other - Middle Name:
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-3502
Mailing Address - Country:US
Mailing Address - Phone:918-647-8457
Mailing Address - Fax:580-298-6723
Practice Address - Street 1:401 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-3502
Practice Address - Country:US
Practice Address - Phone:918-649-0230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator