Carly Pruckner, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4369 Issued in TN

Practice address

1624 Riverside Dr
Nashville, TN 37216-4012

Phone

(814) 440-1977

NPI assigned

Dec 9, 2020

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

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: carly.pruckner@488678167609348.direct.elationemr.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Crossroads Medical Group, PLLC

  • Clinic/Center
  • White House, TN
  • NPI 1073539607
  Medicare reassignment

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

{
    "created_epoch": "1607472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677801600000",
    "number": "1659977155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1624 RIVERSIDE DR",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372164012",
            "telephone_number": "814-440-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1624 RIVERSIDE DR",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372164012",
            "telephone_number": "814-440-1977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUCKNER",
        "first_name": "CARLY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-09",
        "last_updated": "2023-03-03",
        "certification_date": "2023-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "4369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Providence Care Inc
• Provider Guidance LLC
• Gwen Provo-Bell, MD
• Jonathon Prozan, PHYSICIAN ASSISTANT
• Morgan Kate Prozan
• Heidi Prude
• Natshia Desmonique Prude
• Adam Prudoff, MD
• Brandon Earle Pruett, M.D.
• Ellen Pruett

• Physician Assistant in Nashville, TN
• Providers in Nashville, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.