Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jackson Pruett

Individual provider Independent Duty Corpsman · NPI 1407634272

Jackson Pruett is an Independent Duty Corpsman in Fpo, Aa, California. Practices as a sole proprietor. Registered with an NPI since 2023.

In the registry since
2023
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Practice location Address checks out

Bldg 4101 El Camino Real
Fpo, Aa, CA 92058
Phone: (760) 725-1288
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Independent Duty Corpsman (primary) Taxonomy 1710I1002X

Record details

NPI number1407634272
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedSeptember 21, 2023
Last updated in NPPESSeptember 21, 2023
Certification dateSeptember 5, 2023