Provider Demographics
NPI:1861530578
Name:PRUITT, LINDA (CNS, MSN, RN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:PRUITT
Suffix:
Gender:F
Credentials:CNS, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4847 E VIRGINIA ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-2611
Mailing Address - Country:US
Mailing Address - Phone:812-479-1242
Mailing Address - Fax:
Practice Address - Street 1:4847 E VIRGINIA ST
Practice Address - Street 2:SUITE D
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2611
Practice Address - Country:US
Practice Address - Phone:812-479-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28066540A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health