Individual
SHELLEY PRUITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
701 ARKANSAS BLVD, TEXARKANA, AR 71854-2105
(870) 772-5028
Mailing address
701 ARKANSAS BLVD, TEXARKANA, AR 71854-2105
(870) 772-5028
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R32527
AR
Other
Enumeration date
12/29/2015
Last updated
12/29/2015
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