Provider Demographics
NPI:1710587720
Name:PAUGH, JOHNNA
Entity Type:Individual
Prefix:
First Name:JOHNNA
Middle Name:
Last Name:PAUGH
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 1:27 MIDWAY LOOP
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-1373
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 MCCALL RUN RD
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WV
Practice Address - Zip Code:26280-1135
Practice Address - Country:US
Practice Address - Phone:304-335-0561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide