Individual
DIANA S PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
260 FORT SANDERS WEST BLVD, KNOXVILLE, TN 37922-3355
(865) 769-4500
Mailing address
260 FORT SANDERS WEST BLVD, KNOXVILLE, TN 37922-3355
(865) 769-4500
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2079
TN
363AS0400X
Surgical Physician Assistant
2079
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1529126
—
TN
01
—
4327113
BLUECROSS BLUESHIELD
TN
01
—
6002898
BLUECROSS BLUESHIELD PA SURGICAL
TN
01
—
P01253152
RAILROAD MEDICARE
TN
Enumeration date
04/04/2012
Last updated
02/10/2014
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