Individual
MRS. ANNIE SEAL PRUITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1410 CLOVER LN, WEST MEMPHIS, AR 72301-1718
(870) 702-6710
Mailing address
2416 E BARTON AVE APT 502, WEST MEMPHIS, AR 72301-2322
(901) 315-6294
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166112783
—
AR
Enumeration date
04/30/2008
Last updated
04/30/2008
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