Individual
MICHELLE PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4381 S EASON BLVD, TUPELO, MS 38801-6583
(662) 377-5468
Mailing address
4381 S EASON BLVD, TUPELO, MS 38801-6583
(662) 377-5468
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0463
MS
Other
Enumeration date
03/19/2014
Last updated
03/19/2014
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