Provider Demographics
NPI:1760973424
Name:PAULEY, AMELIA L (PMHNP)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:L
Last Name:PAULEY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:L
Other - Last Name:MCCLURE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP
Mailing Address - Street 1:14469 CHAUNCEY RD
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:IL
Mailing Address - Zip Code:62466-4306
Mailing Address - Country:US
Mailing Address - Phone:812-891-3410
Mailing Address - Fax:
Practice Address - Street 1:410 E MACK AVE
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2319
Practice Address - Country:US
Practice Address - Phone:618-395-7421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28191422A163W00000X
IN71008296A363LP0808X
IL209019285363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse