Individual
TIFFANY PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
712B SAINT JOHN ST, GARDEN CITY, KS 67846-5128
(620) 275-1766
(275) 275-4729
Mailing address
712B SAINT JOHN ST, GARDEN CITY, KS 67846-5128
(620) 275-1766
(275) 275-4729
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
13-91395-121
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13-91395-121
KANSAS STATE BOARD OF NUR
KS
Enumeration date
05/21/2007
Last updated
07/08/2007
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