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General NPI Number Information
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NPI Number | 1760973424
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Entity Type | Individual
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Provider Name | AMELIA L PAULEY PMHNP
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Gender | Female
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 09/10/2021
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Provider Practice Location Address
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Address Line | 410 E MACK AVE
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City | OLNEY
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State | IL
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Zip | 62450-2319
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Country | US
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Telephone | 618-395-7421
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Fax |
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Provider Business Mailing Address
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Address Line | 14469 CHAUNCEY RD
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City | SUMNER
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State | IL
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Zip | 62466-4306
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Country | US
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Telephone | 812-891-3410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 28191422A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71008296A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209019285
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License Number State | IL
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