Provider Demographics
NPI:1053196493
Name:PAULEY, STEPHANIE MICHELL
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELL
Last Name:PAULEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5232 WALNUT VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-2155
Mailing Address - Country:US
Mailing Address - Phone:304-840-3013
Mailing Address - Fax:
Practice Address - Street 1:5232 WALNUT VALLEY DR
Practice Address - Street 2:
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-2155
Practice Address - Country:US
Practice Address - Phone:304-840-3013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant