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Individual
MADISON K PRUITT
Active
Individual
MADISON K PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
05815
KY
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
05815
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2021
Last updated
08/04/2025
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