Individual
EDWARD TREY PRUIETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
204 MISSISSIPPI ST S, WYNNE, AR 72396-3025
(870) 208-8499
Mailing address
204 MISSISSIPPI ST S, WYNNE, AR 72396-3025
(870) 208-8499
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/11/2022
Last updated
10/11/2022
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