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Individual

KELLI ELIZABETH PRUITT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2969 CURRAN DR N, JACKSON, MS 39216-4121
(601) 540-5598
Mailing address
2969 CURRAN DR N, JACKSON, MS 39216-4121
(601) 540-5598

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
APRN11007306
FL
363LF0000X
Family Nurse Practitioner
Primary
R883741
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
10006919
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP61401686
WA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
APRN11007306
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
R883741
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
07407051
MS
Enumeration date
06/27/2014
Last updated
05/31/2023
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