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Individual

MS. KIMBERLY DAWN PRUITT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
740 S LIMESTONE, STE L304, LEXINGTON, KY 40536
(859) 323-6494
(859) 257-2573
Mailing address
PO BOX 936, LONDON, KY 40743-0936

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
3008160
KY
363LF0000X
Family Nurse Practitioner
Primary
3008160
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100254950
KY
Enumeration date
07/09/2013
Last updated
03/22/2021
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