Individual
JENNIE PRUITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
747 HIGHWAY 59 STE 4, WESTVILLE, OK 74965
(479) 220-9857
Mailing address
747 HIGHWAY 59 STE 4, WESTVILLE, OK 74965-1508
(479) 220-9857
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/31/2012
Last updated
08/21/2018
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