Individual
DR. TIMOTHY MICHAEL PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP
Contact information
Practice address
7601 SOUTHCREST PKWY, SOUTHAVEN, MS 38671
(662) 772-4200
Mailing address
5381 ALLEN RD, HERNANDO, MS 38632-9608
(502) 810-4146
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
19099
TN
363L00000X
Nurse Practitioner
Primary
893878
MS
363L00000X
Nurse Practitioner
A001384
AR
363L00000X
Nurse Practitioner
RN298030
GA
363LA2100X
Acute Care Nurse Practitioner
19099
TN
363LA2100X
Acute Care Nurse Practitioner
893878
MS
363LA2100X
Acute Care Nurse Practitioner
A001384
AR
363LA2100X
Acute Care Nurse Practitioner
RN298030
GA
363LF0000X
Family Nurse Practitioner
RN298030
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08379272
—
MS
05
—
136263758
—
AR
Enumeration date
05/30/2005
Last updated
07/29/2025
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