Provider Demographics
NPI:1174411060
Name:PAUGH, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PAUGH
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 SHOCKEY RD
Mailing Address - Street 2:
Mailing Address - City:OLD FIELDS
Mailing Address - State:WV
Mailing Address - Zip Code:26845-8626
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:966 SHOCKEY RD
Practice Address - Street 2:
Practice Address - City:OLD FIELDS
Practice Address - State:WV
Practice Address - Zip Code:26845-8626
Practice Address - Country:US
Practice Address - Phone:304-490-1094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide