Lisa Pruitt, RN, IBCLC

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN141119 Issued in GA

Practice address

2400 Mount Zion Pkwy
Jonesboro, GA 30236-2500

Phone

(770) 603-3671

NPI assigned

Mar 31, 2017

Last updated

Mar 31, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1490918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490918400000",
    "number": "1740712454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5557 PLATTE DR",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302946657",
            "telephone_number": "404-610-7010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 MOUNT ZION PKWY",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302362500",
            "telephone_number": "770-603-3671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUITT",
        "first_name": "LISA",
        "credential": "RN, IBCLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-31",
        "last_updated": "2017-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN141119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Nurse in Jonesboro, GA
• Providers in Jonesboro, GA by specialty
• Registered Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 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.

Verify at the official NPI Registry.