Individual
EMILY DIANE PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2106 LOOP RD, WINNSBORO, LA 71295-3344
(318) 435-9411
(318) 435-9260
Mailing address
2106 LOOP RD, WINNSBORO, LA 71295-3344
(318) 435-9411
(318) 435-9260
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP10208
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14296793
CAQH
—
05
—
2478486
—
LA
01
—
F07181660
CERTIFICATION
—
Enumeration date
07/06/2018
Last updated
09/21/2018
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