Provider Demographics
NPI:1518944255
Name:PAULEY, DEANNA RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:RAE
Last Name:PAULEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:RAE
Other - Last Name:VANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 1171
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25053-1171
Mailing Address - Country:US
Mailing Address - Phone:304-688-4100
Mailing Address - Fax:304-688-4100
Practice Address - Street 1:555 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508
Practice Address - Country:US
Practice Address - Phone:304-688-9901
Practice Address - Fax:304-688-9904
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01208363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810024397Medicaid
WV3810024397Medicaid
WVWV2042AMedicare PIN