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Individual

TERRI AMANDA PRUITT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN-CNP

Contact information

Practice address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 458-3100
Mailing address
1555 REDWOOD PL, TAHLEQUAH, OK 74464-6050
(918) 931-2996

Taxonomy

Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
88775
OK

Other

Enumeration date
06/24/2018
Last updated
06/24/2018
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