Individual
MR. KELLY D PRUETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APN
Contact information
Practice address
1300 ANNE ST NW, BEMIDJI, MN 56601-5103
(218) 751-9746
(605) 328-6512
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
7888
MN
363L00000X
Nurse Practitioner
A003595
AR
Other
Enumeration date
12/01/2006
Last updated
01/22/2021
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