Provider Demographics
NPI:1639898604
Name:PAULEY, JESSICA L
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:PAULEY
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 1:4786 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:YAWKEY
Mailing Address - State:WV
Mailing Address - Zip Code:25573-9730
Mailing Address - Country:US
Mailing Address - Phone:304-546-8124
Mailing Address - Fax:
Practice Address - Street 1:4786 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:YAWKEY
Practice Address - State:WV
Practice Address - Zip Code:25573-9730
Practice Address - Country:US
Practice Address - Phone:304-546-8124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant