Provider Demographics
NPI:1265055867
Name:PAULEY, ERICA C (LPN, QMHS)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:C
Last Name:PAULEY
Suffix:
Gender:F
Credentials:LPN, QMHS
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:C
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:PO BOX 1507
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-1507
Mailing Address - Country:US
Mailing Address - Phone:740-354-7702
Mailing Address - Fax:740-353-6206
Practice Address - Street 1:901 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3944
Practice Address - Country:US
Practice Address - Phone:740-354-7702
Practice Address - Fax:740-353-6206
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.163410-MEDS-IV171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLPN.163410-MEDS-IVOtherOH LICENSE