Active NPI
Lysiane Pruitt, FNP
- Family Nurse Practitioner
- Fayetteville, NC
National Provider Identifier
1164528030
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 122251
- Practice address
- 2300 Ramsey St
Fayetteville, NC 28301-3856 - Phone
- (910) 488-2120
- NPI assigned
- Sep 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 122251 | NC | Primary |
Addresses
Primary practice location
2300 Ramsey St
Fayetteville, NC 28301-3856
Mailing address
2300 Ramsey St
Fayetteville, NC 28301-3856
Phone (910) 488-2120
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122251 | NC | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491609600000",
"number": "1164528030",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2300 RAMSEY ST",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283013856",
"telephone_number": "910-488-2120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 RAMSEY ST",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283013856",
"telephone_number": "910-488-2120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRUITT",
"first_name": "LYSIANE",
"name_prefix": "Mrs.",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-16",
"last_updated": "2017-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NC",
"license": "122251",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.