Provider Demographics
NPI:1871295592
Name:PRUITT, CARESA A (FNP-C)
Entity type:Individual
Prefix:
First Name:CARESA
Middle Name:A
Last Name:PRUITT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17187 FM 529 RD, STE 109
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-6330
Mailing Address - Country:US
Mailing Address - Phone:832-810-9021
Mailing Address - Fax:
Practice Address - Street 1:17187 FM 529 RD, STE 109
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-6330
Practice Address - Country:US
Practice Address - Phone:832-810-9021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1063466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily