Provider Demographics
NPI:1316624331
Name:PAULEY, TRACIA LYNN
Entity type:Individual
Prefix:
First Name:TRACIA
Middle Name:LYNN
Last Name:PAULEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 WESTBROOK LN
Mailing Address - Street 2:
Mailing Address - City:PEYTONA
Mailing Address - State:WV
Mailing Address - Zip Code:25154-7000
Mailing Address - Country:US
Mailing Address - Phone:304-833-0738
Mailing Address - Fax:
Practice Address - Street 1:46 FRIENDLY NEIGHBOR DRIVE
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508
Practice Address - Country:US
Practice Address - Phone:304-855-7104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28080164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse