Provider Demographics
NPI:1255460200
Name:PRUITT, WESLEY BLAKE (MD)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:BLAKE
Last Name:PRUITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MCDOWELL ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4104
Mailing Address - Country:US
Mailing Address - Phone:828-258-8545
Mailing Address - Fax:828-254-0714
Practice Address - Street 1:10 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4104
Practice Address - Country:US
Practice Address - Phone:828-258-8545
Practice Address - Fax:828-254-0714
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-00694207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC161JHOtherBLUE CROSS BLUE SHIELD NC
NC5914635Medicaid
NC161JHOtherBLUE CROSS BLUE SHIELD NC
NC5914635Medicaid