Individual
JENNY M PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
58 CARROLL ST, ROOM 2037, LEBANON, VA 24266
(276) 883-8062
(276) 883-8064
Mailing address
58 CARROLL ST, ROOM 2037, LEBANON, VA 24266
(276) 883-8062
(276) 883-8064
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110002659
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528249133
—
VA
05
—
Q013872
—
TN
Enumeration date
11/26/2007
Last updated
02/23/2017
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