Healthcare Provider Details

I. General information

NPI: 1518944255
Provider Name (Legal Business Name): DEANNA RAE PAULEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEANNA RAE VANCE PA-C

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MAIN STREET
CHAPMANVILLE WV
25508
US

IV. Provider business mailing address

PO BOX 1171
DANVILLE WV
25053-1171
US

V. Phone/Fax

Practice location:
  • Phone: 304-688-9901
  • Fax: 304-688-9904
Mailing address:
  • Phone: 304-688-4100
  • Fax: 304-688-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number01208
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number01208
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: