Provider Demographics
NPI:1386974426
Name:PRUITT-ORR, SHELIA
Entity type:Individual
Prefix:
First Name:SHELIA
Middle Name:
Last Name:PRUITT-ORR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 S 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-7205
Mailing Address - Country:US
Mailing Address - Phone:956-686-5692
Mailing Address - Fax:956-383-8864
Practice Address - Street 1:1304 S 25TH AVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-7205
Practice Address - Country:US
Practice Address - Phone:956-686-5692
Practice Address - Fax:956-383-8864
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX522420163W00000X
TXAP104901363LA2200X, 364SP1700X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No364SP1700XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerinatal
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health