Provider Demographics
NPI:1144830050
Name:PAULEY, CARISSA (RN)
Entity type:Individual
Prefix:MRS
First Name:CARISSA
Middle Name:
Last Name:PAULEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 DECATUR AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5407
Mailing Address - Country:US
Mailing Address - Phone:304-588-0598
Mailing Address - Fax:
Practice Address - Street 1:67670 TRACO DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-9375
Practice Address - Country:US
Practice Address - Phone:740-695-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV100284163WP0200X
OH461682163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0200XNursing Service ProvidersRegistered NursePediatrics