Ellyn Burton Pruett, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R885026 Issued in MS

Practice address

2500 N State St
Jackson, MS 39216-4500

Phone

(601) 984-4540

Fax

(601) 984-4548

NPI assigned

Oct 14, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1381708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434585600000",
    "number": "1407284276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "address_2": "DIVISION OF GASTROENTEROLOGY",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-4540",
            "fax_number": "601-984-4548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-4540",
            "fax_number": "601-984-4548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUETT",
        "first_name": "ELLYN",
        "middle_name": "BURTON",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-14",
        "last_updated": "2015-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R885026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "P01454802",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01504791",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bryan D Propes, M.D.
• Prosperity Counseling Service LLC
• Adam Nicholas Protos, M.D.
• Providence Hospice, LLC
• Thomas Prude, PCMHT
• Eleanor Karen Pruitt, DMD
• Kelli Elizabeth Pruitt
• Shapard H Pryor Jr., MD
• Tyranny Pryor
• Rick A Psonak, CPO

• Family Nurse Practitioner in Jackson, MS
• Providers in Jackson, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.