Individual
KELLY ELIZABETH PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
3500 RAINBOW DR, RAINBOW CITY, AL 35906-6310
(256) 442-3208
Mailing address
105 COUNTY ROAD 936, CENTRE, AL 35960-8638
(256) 304-4167
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1-122055
AL
363LF0000X
Family Nurse Practitioner
1-122055
AL
Other
Enumeration date
08/23/2022
Last updated
07/16/2024
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