Individual provider Active NPI

Emily Diane Pruitt

  • Family Nurse Practitioner
  • Winnsboro, LA
National Provider Identifier
1760978449
Registry record updated Sep 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP10208 Issued in LA
Practice address
2106 Loop Rd
Winnsboro, LA 71295-3344
Phone
(318) 435-9411
Fax
(318) 435-9260
NPI assigned
Jul 6, 2018
Last updated
Sep 21, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP10208 LA Primary

Addresses

Primary practice location

2106 Loop Rd
Winnsboro, LA 71295-3344

Mailing address

2106 Loop Rd
Winnsboro, LA 71295-3344
Phone (318) 435-9411

Other identifiers 3

IdentifierTypeStateIssuer
F07181660OtherCERTIFICATION
14296793OtherCAQH
2478486MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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

Enrollment IDStateProvider typePAC IDDetails
I20180829001302 LA Practitioner - Nurse Practitioner 0446500284 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Calcasieu Urgent Care LLCGroup PAC ID 5496908071, 132 clinicians

Practice addresses (Care Compare)

57 Pinecrest Dr
Pineville, LA 71360-4284
Phone (318) 232-6071

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP10208LAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lsu Health Sciences Center Shreveport Faculty Group Practice CurrentSince Nov 1, 2024 Accepting new patients
Calcasieu Urgent Care, LLC CurrentSince Dec 19, 2023 Accepting new patients
Upperline Healthcare, PC CurrentSince Nov 1, 2025 Accepting new patients
Calcasieu Urgent Care LLC CurrentSince Dec 19, 2023 Accepting new patients
Upperline Healthcare, PC CurrentSince Nov 1, 2025 Accepting new patients
Franklin Parish Hospital Service Dist 1 CurrentSince Aug 16, 2018 Accepting new patients
Franklin Parish Hospital Service Dist 1 CurrentSince Aug 16, 2018 Accepting new patients

Locations

2640 Country Club Rd
Ste 400
Lake Charles, LA 70605
Phone (337) 426-0919

1121 Polk St
Mansfield, LA 71052
Phone (318) 575-2143

4864 Jackson St
Monroe, LA 71202
Phone (318) 330-7000

57 Pinecrest Dr
Pineville, LA 71360
Phone (318) 232-6071

1541 Kings Hwy
Shreveport, LA 71103
Phone (318) 626-0287

1606 Kings Hwy
Shreveport, LA 71103
Phone (318) 675-6402

132 Well Rd
West Monroe, LA 71291
Phone (318) 217-6521

2104 Loop Rd
Ste C
Winnsboro, LA 71295
Phone (318) 435-4571

2106 Loop Rd
Winnsboro, LA 71295
Phone (318) 282-8482

5745 Highway 17
Winnsboro, LA 71295
Phone (318) 722-3333

Interoperability endpoints

  • Direct secure messaging: diane.pruitt.1@13199.direct.athenahealth.com

Organizations & group practices 7

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

NPI Registry JSON

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

{
    "created_epoch": "1530835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537488000000",
    "number": "1760978449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2106 LOOP RD",
            "city": "WINNSBORO",
            "state": "LA",
            "postal_code": "712953344",
            "telephone_number": "318-435-9411",
            "fax_number": "318-435-9260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2106 LOOP RD",
            "city": "WINNSBORO",
            "state": "LA",
            "postal_code": "712953344",
            "telephone_number": "318-435-9411",
            "fax_number": "318-435-9260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUITT",
        "first_name": "EMILY",
        "middle_name": "DIANE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-06",
        "last_updated": "2018-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "AP10208",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFICATION",
            "identifier": "F07181660",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "14296793",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2478486",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winnsboro, LA

Sources for this page

Verify at the official NPI Registry.