Healthcare Provider Details

I. General information

NPI: 1336941772
Provider Name (Legal Business Name): STEVIE SUE ANN PLYMALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 HUDGINS ST
LOGAN WV
25601-3535
US

IV. Provider business mailing address

313 HUDGINS ST
LOGAN WV
25601-3535
US

V. Phone/Fax

Practice location:
  • Phone: 304-752-7830
  • Fax: 304-752-7832
Mailing address:
  • Phone: 304-752-7830
  • Fax: 304-752-7832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: