| NPI | 1083887897 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK A PRUITT Owner 865-922-4434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN RN121028) |
| Enumeration Date | 2008-04-12 |
| Last Update Date | 2008-04-16 |