Individual
AMANDA KINNEY PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2430 REIDVILLE RD, SPARTANBURG, SC 29301-3652
(864) 516-1783
Mailing address
2430 REIDVILLE RD, SPARTANBURG, SC 29301-3652
(864) 516-1783
(864) 594-0040
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
51900
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
519004
—
SC
01
—
SCD3684862
MEDICARE
SC
01
—
SCD368J577
MEDICARE PIN
SC
01
—
SCF2976067
MEDICARE PIN
SC
01
—
SCF2976084
MEDICARE PIN
SC
01
—
SCF2976121
MEDICARE PIN
SC
Enumeration date
04/10/2015
Last updated
06/23/2025
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