MEDICARE: PLUM LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QP2300X	Primary Care Clinic/Center
2	363LP0200X	Pediatric Nurse Practitioner
3	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1114675253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLUM LLC

Provider Business Mailing Address
First Line	:	4320 WOOD DR
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79707-1904
Country	:	US
Telephone Number	:	432-288-8482
Fax Number	:

Provider Business Practice Location Address
First Line	:	807 TRADEWINDS BLVD
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79706-3163
Country	:	US
Telephone Number	:	432-288-8482
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	DR. AMANDA JO HUGHES
Credential	:	DNP, APRN, NNP, PNP
Telephone Number	:	432-288-8482

Provider Enumeration Date	:	03/17/2022
Last Update Date	:	07/15/2022

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Directions to “PLUM LLC ” Practice Location

Language	Start Address	Practice Location

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