Provider Demographics
NPI:1144515123
Name:PRUITT, JESSIE RAYLENE (CRT RCP)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:RAYLENE
Last Name:PRUITT
Suffix:
Gender:F
Credentials:CRT RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6652 CANYON DR
Mailing Address - Street 2:#3
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-7011
Mailing Address - Country:US
Mailing Address - Phone:806-322-0941
Mailing Address - Fax:806-322-0942
Practice Address - Street 1:6652 CANYON DR
Practice Address - Street 2:#3
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-7011
Practice Address - Country:US
Practice Address - Phone:806-322-0941
Practice Address - Fax:806-322-0942
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX595082278H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health