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JACKSON PRUETT
NPI 1407634272
Military Health Care Provider - Independent Duty Corpsman in Fpo, Aa, CA

Active since September 21, 2023
BLDG 4101, EL CAMINO REAL, FPO, AA, CA 92058(760) 725-1288 Get Directions Write a Review

NPPES record last updated: September 21, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jackson Pruett NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACKSON PRUETT (NPI 1407634272) is an individual independent duty corpsman provider in Fpo, Aa, California and active in the NPI registry since September 2023.

NPPES Registry Identity

NPI1407634272
Entity TypeIndividualMale
Primary Taxonomy1710I1002X
Provider Legal NameJACKSON PRUETT
Location AddressBLDG 4101, EL CAMINO REALFpo, Aa, CA 92058
Mailing AddressPo Box 555584Oceanside, CA 92055-5584 · (760) 725-8912
Phone(760) 725-1288
Sole ProprietorYes
Enumeration DateSeptember 21, 2023
NPPES CertifiedSeptember 5, 2023
✔ NPI 1407634272 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMilitary Health Care Provider · Independent Duty CorpsmanOther Service Providers
Taxonomy Code1710I1002X
Definition
A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals.
BLDG 4101, EL CAMINO REAL, Fpo, Aa, CA 92058
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackson Pruett's NPI number?

The NPI number for Jackson Pruett is 1407634272. It was assigned to this individual provider in the NPPES registry on September 21, 2023.

Where is Jackson Pruett located?

Jackson Pruett practices at Bldg 4101, El Camino Real, Fpo, Aa, CA 92058. The listed phone number is (760) 725-1288.

What is Jackson Pruett's specialty?

The primary specialty registered for this NPI is Military Health Care Provider, specializing in Independent Duty Corpsman, with taxonomy code 1710I1002X.

When was this NPI record last updated?

The NPPES record for Jackson Pruett was last updated on September 21, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.