Most Relevant Information
Provider Data
| NPI Number: | 1003546789 |
| Provider Name: | STACIE LEAH PRUETT FNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 2022021022 |
Most Important Dates
| Enumeration Date: | 06/15/2022 |
| Last Updated: | 06/15/2022 |
Provider Practice Location
24221 S ROCKHAVEN RD
PECULIAR
MO
640789679
Practice Location Phone/Fax
| Phone: | 8163085877 |
| Fax: |
Provider Mailing Location
24221 S ROCKHAVEN RD
PECULIAR
MO
640789679
Provider Mailing Phone/Fax
| Phone: | 8163085877 |
| Fax: |