Provider Demographics
NPI:1104161017
Name:PRITCHETTE, LOUELLA (DO)
Entity type:Individual
Prefix:
First Name:LOUELLA
Middle Name:
Last Name:PRITCHETTE
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:LOUELLA
Other - Middle Name:A
Other - Last Name:PRITCHETTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:500 MEMORIAL CIR STE C
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5054
Mailing Address - Country:US
Mailing Address - Phone:386-615-3500
Mailing Address - Fax:386-615-3505
Practice Address - Street 1:500 MEMORIAL CIR STE C
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5054
Practice Address - Country:US
Practice Address - Phone:386-615-3500
Practice Address - Fax:386-615-3505
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16989207Q00000X
PAOS016813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty