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General NPI Number Information
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NPI Number | 1114675253
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Entity Type | Organization
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Legal Business Name | PLUM LLC
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Dates
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Enumeration Date | 03/17/2022
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 807 TRADEWINDS BLVD
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City | MIDLAND
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State | TX
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Zip | 79706-3163
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Country | US
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Telephone | 432-288-8482
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Fax |
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Provider Business Mailing Address
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Address Line | 4320 WOOD DR
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City | MIDLAND
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State | TX
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Zip | 79707-1904
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Country | US
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Telephone | 432-288-8482
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | DR. AMANDA JO HUGHES
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Credential | DNP, APRN, NNP, PNP
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Telephone | 432-288-8482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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