Healthcare Provider Details

I. General information

NPI: 1003079328
Provider Name (Legal Business Name): KAREN PAULEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S STATE ST
MARION OH
43302-5000
US

IV. Provider business mailing address

22100 STATE ROUTE 245
MARYSVILLE OH
43040-8005
US

V. Phone/Fax

Practice location:
  • Phone: 740-387-4115
  • Fax: 740-387-9210
Mailing address:
  • Phone: 937-642-6274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50000436
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: