DR. JOHN ROBERT PRUETT JR. (NPI# 1134146632) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134146632 |
| Entity Type | Individual |
| Full Name | DR. JOHN ROBERT PRUETT JR. |
| Credential | MD |
| Practice Address |
4444 Forest Park Ave Ste 2600 Ste 2600 Saint Louis MO 63108-2212 |
| Mailing Address |
660 S Euclid Ave C B 8134 Saint Louis MO 63110-1010 |
| Practice Telephone | 3142861700 |
| Practice Fax Number | 3142861799 |
| Mailing Telephone | 3142861700 |
| Mailing Fax Number | 3142861777 |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2018-01-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
2002002107 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | ENROLLED | 05 | |
| MO | 207238700 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760508436 | John Parr Pruett | Dentist | 384 Hartnell Ave, Suite B, Redding, CA 96002-1884 | 2007-03-22 |
| 1225661945 | John Robert Pruett | Social Worker | 146 Communication Dr, Hannibal, MO 63401-3672 | 2020-02-20 |
| 1184283525 | John Pruett | Behavioral Analyst | 150 W University Blvd, Melbourne, FL 32901-6982 | 2019-06-10 |
| 1518495753 | John Thomas Pruett | Social Worker | 100 Teptal Ter, Bryson City, NC 28713-5479 | 2017-06-01 |
| 1104039494 | John H Pruett Jr. | Counselor | 602 Abbey Ct, Alpharetta, GA 30004-6005 | 2007-05-07 |
| 1881623106 | John W Pruett | Psychiatry & Neurology | 1240 E 9th St, Reno, NV 89512-2964 | 2006-06-30 |
| Street Address |
4444 FOREST PARK AVE STE 2600 STE 2600 |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63108-2212 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295735876 | Cynthia L Woodcock | Nurse Practitioner | 4444 Forest Park Ave Ste 2600, Ste 2600, Saint Louis, MO 63108-2212 | 2005-07-26 |
| 1477183689 | Shae Lynn Strom | Social Worker | 4444 Forest Park Ave Ste 2600, Saint Louis, MO 63108-2212 | 2020-01-16 |
| 1386284990 | Virginia Cozon Lanzotti | Nurse Practitioner | 4444 Forest Park Ave Ste 2600, Saint Louis, MO 63108-2212 | 2020-01-11 |
| 1255845863 | Laura Weilbacher Rayhawk | Counselor | 4444 Forest Park Ave Ste 2600, Ste 2600, Saint Louis, MO 63108-2212 | 2017-11-20 |
| 1699126706 | Celina Rose Jacobi | Psychiatry & Neurology | 4444 Forest Park Ave Ste 2600, Saint Louis, MO 63108-2212 | 2016-06-29 |
| 1699138495 | Martin Huynh | Psychiatry & Neurology | 4444 Forest Park Ave Ste 2600, Saint Louis, MO 63108-2212 | 2016-03-30 |
| 1114396330 | Michael S Gaffrey | Psychologist | 4444 Forest Park Ave Ste 2600, Ste 2600, Saint Louis, MO 63108-2212 | 2015-09-17 |
| 1255714663 | Ankita Kantilal Vora | Student in an Organized Health Care Education/Training Program | 4444 Forest Park Ave Ste 2600, Saint Louis, MO 63108 | 2015-07-02 |
| 1699152249 | Brian Bui | Psychiatry & Neurology | 4444 Forest Park Ave Ste 2600, Saint Louis, MO 63108 | 2015-05-04 |
| 1366830978 | Angela Marie Williams | Nurse Practitioner | 4444 Forest Park Ave Ste 2600, Ste 2600, Saint Louis, MO 63108-2212 | 2015-01-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346851474 | Nigel Austen Thomas Cook | Social Worker | 4050 West Pine Blvd. Apt. 4118, St. Louis, MO 63108 | 2020-08-12 |
| 1467070011 | C2n Diagnostics, LLC | Clinical Medical Laboratory | 20 South Sarah Street, Saint Louis, MO 63108 | 2020-07-10 |
| 1609414358 | Kaylee Breitenbucher | Occupational Therapist | 4444 Forest Park Avenue, Msc 8505-94-01, St. Louis, MO 63108 | 2019-12-12 |
| 1114419546 | Activangels Home Health | Home Health | 4625 Lindell Blvd Ste 304, Saint Louis, MO 63108 | 2018-06-01 |
| 1215427349 | Heart To Heart Consolidated Home Care Service LLC | Home Health | 4625 Lindell Blvd Ste 200, Saint Louis, MO 63108 | 2018-05-15 |
| 1447755905 | Erin Virginia Adams | Student in an Organized Health Care Education/Training Program | 4355 Maryland Ave Apt 116, Saint Louis, MO 63108 | 2018-03-27 |
| 1033621172 | Roots Healthcare and Homes | In Home Supportive Care | 4300 Enright Ave, St. Louis, MO 63108 | 2017-10-30 |
| 1336661719 | House of Destiny Adult Day Care LLC | Clinic/Center | 4507 Olive Street, St Louis, MO 63108 | 2017-07-07 |
| 1003338492 | Khin Min Thu | Social Worker | 4236 Lindell Blvd., Suite 200, St Louis, MO 63108 | 2017-07-07 |
| 1679093967 | Together We Can Home Healthcare Services LLC | Home Health | 4144 Lindell Blvd Suite 221, Saint Louis, MO 63108 | 2017-06-27 |
| Find all providers in zip 63108 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730622929 | Judith Hood Mckelvey | Psychiatry & Neurology | 9861 Copper Hill Rd, Saint Louis, MO 63124-1063 | 2016-11-21 |
| 1629332259 | Oksana Baram | Psychiatry & Neurology | 10420 Old Olive Street Rd Ste 204, Saint Louis, MO 63141-5938 | 2012-06-28 |
| 1689881567 | Pearl Fisher Serota | Psychiatry & Neurology | 621 S New Ballas Rd Ste 693a, Saint Louis, MO 63141-8263 | 2007-05-17 |
| 1154536100 | Rekha Ramanuja | Psychiatry & Neurology | 1220 N Lindbergh Blvd, Saint Louis, MO 63132-1704 | 2007-05-13 |
| 1215972948 | Gary H Boxer | Psychiatry & Neurology | 24 S Kingshighway Blvd, Saint Louis, MO 63108-1301 | 2006-06-17 |
| 1265956544 | Family Psychiatry LLC | Psychiatry & Neurology | 10420 Old Olive Street Rd, Saint Louis, MO 63141-5914 | 2017-07-28 |
| 1699138495 | Martin Huynh | Psychiatry & Neurology | 4444 Forest Park Ave Ste 2600, Saint Louis, MO 63108-2212 | 2016-03-30 |
| 1225490881 | Ian Leonard Pearson | Psychiatry & Neurology | 660 S Euclid Ave, Saint Louis, MO 63110-1010 | 2016-03-23 |
| 1255715793 | Max Samuel Rosen | Psychiatry & Neurology | 4444 Forest Park Ave, Ste 2600, Saint Louis, MO 63108-2212 | 2015-07-15 |
| 1699152249 | Brian Bui | Psychiatry & Neurology | 4444 Forest Park Ave Ste 2600, Saint Louis, MO 63108 | 2015-05-04 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63108 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.