Individual
JESSICA PRUITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1638 OLD GOLDEN HWY, BROKEN BOW, OK 74728-6846
(580) 236-3575
Mailing address
1638 OLD GOLDEN HWY, BROKEN BOW, OK 74728-6846
(580) 236-3575
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/15/2014
Last updated
04/15/2014
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