Pruitt, Timothy Michael
Pruitt, Timothy Michael is an individual health care provider with primary practice located at 7601 Southcrest Pkwy , Southaven MS 38671. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Acute Care, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is his primary health care specialty. Pruitt, Timothy Michael can be contacted via phone (662) 772-4200.Contact Information
Primary practice address
7601 Southcrest Pkwy
Southaven MS 38671
Phone: (662) 772-4200
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Acute Care | 363LA2100X | 19099 | Tennessee |
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | A001384 | Arkansas |
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | 19099 | Tennessee |
| Physician Assistants & Advanced Practice Nursing Providers / Acute Care | 363LA2100X | 893878 | Mississippi |
| Physician Assistants & Advanced Practice Nursing Providers / Acute Care | 363LA2100X | A001384 | Arkansas |
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | 893878 | Mississippi |
Profile Details
| NPI number | 1295738706 |
|---|---|
| LBN Legal business name | Pruitt, Timothy Michael |
| Credentials | DNP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 30th, 2005 |
| Last updated | May 12th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1295738706 | NPPES |
| Arkansas | MEDICAID | 136263758 | |
| Arkansas | MEDICAID | 08379272 |
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