Individual
CHRISTOPHER RYAN PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1400 HIGHLAND RD, RICHMOND, IN 47374-8809
(765) 935-8905
(765) 939-4200
Mailing address
1100 REID PKWY, MEDICAL STAFF SERVICES, RICHMOND, IN 47374-1157
(765) 935-8806
(765) 983-3219
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000646A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000767431
ANTHEM
IN
Enumeration date
04/03/2006
Last updated
05/18/2021
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