Individual
JEFFERY PRUDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4253 N. CROSSOVER, FAYETTEVILLE, AR 72703
(479) 464-5925
Mailing address
4253 N. CROSSOVER, FAYETTEVILLE, AR 72704
(479) 464-5925
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/15/2016
Last updated
03/15/2016
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