Individual
MARK A PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
101 DOCTORS PARK, GALAX, VA 24333-2277
(541) 632-4050
(276) 883-6232
Mailing address
101 DOCTORS PARK, GALAX, VA 24333-2277
(276) 595-8921
(276) 883-6232
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0024178316
VA
363L00000X
Nurse Practitioner
Primary
7012
TN
363LA2100X
Acute Care Nurse Practitioner
0024178316
VA
363LA2100X
Acute Care Nurse Practitioner
Primary
7012
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3902626
—
TN
Enumeration date
09/12/2005
Last updated
07/10/2026
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