Individual
KIMBERLY PRUETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
501 20TH ST, SUITE 606, KNOXVILLE, TN 37916-1809
(865) 546-8040
(865) 541-2787
Mailing address
5417 LONAS DR, KNOXVILLE, TN 37909-3220
(865) 212-3662
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
87771
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100031414
PHP TENNCARE
TN
01
—
3149022
BLUECARE
TN
05
—
3630633
—
TN
01
—
430058489
MEDICARE TRAVELERS
TN
Enumeration date
06/20/2006
Last updated
07/08/2007
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