Provider Demographics
NPI:1881916179
Name:PRUITT, MEREDITH (PA-C)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:PRUITT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13921 N MERIDIAN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1106
Mailing Address - Country:US
Mailing Address - Phone:405-752-9600
Mailing Address - Fax:405-752-9650
Practice Address - Street 1:13921 N MERIDIAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1106
Practice Address - Country:US
Practice Address - Phone:405-752-9600
Practice Address - Fax:405-752-9650
Is Sole Proprietor?:No
Enumeration Date:2010-02-27
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1869363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant