Healthcare Provider Details

I. General information

NPI: 1114675253
Provider Name (Legal Business Name): PLUM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 TRADEWINDS BLVD
MIDLAND TX
79706-3163
US

IV. Provider business mailing address

807 TRADEWINDS BLVD
MIDLAND TX
79706-3163
US

V. Phone/Fax

Practice location:
  • Phone: 432-288-8482
  • Fax:
Mailing address:
  • Phone: 432-400-7586
  • Fax: 432-389-7586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA HUGHES
Title or Position: OWNER/PROVIDER
Credential: DNP, APRN, NNP, PNP
Phone: 432-640-1770