Provider Demographics
NPI:1104410703
Name:PRUETT, KALEIGH (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:KALEIGH
Middle Name:
Last Name:PRUETT
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 STATE HIGHWAY 16 S STE 1D
Mailing Address - Street 2:
Mailing Address - City:BANDERA
Mailing Address - State:TX
Mailing Address - Zip Code:78003-3560
Mailing Address - Country:US
Mailing Address - Phone:830-522-2002
Mailing Address - Fax:830-258-6243
Practice Address - Street 1:3540 STATE HIGHWAY 16 S STE 1D
Practice Address - Street 2:
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003-3560
Practice Address - Country:US
Practice Address - Phone:830-522-2002
Practice Address - Fax:830-258-6243
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1027097363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care