Individual
MRS. ELLYN BURTON PRUETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-4540
(601) 984-4548
Mailing address
2500 N STATE ST, DIVISION OF GASTROENTEROLOGY, JACKSON, MS 39216-4500
(601) 984-4540
(601) 984-4548
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R885026
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01504791
—
MS
01
—
P01454802
RAILROAD MEDICARE PTAN
MS
Enumeration date
10/14/2013
Last updated
06/18/2015
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