Basic Information
| Provider Information | |||||||||
| NPI: | 1629513239 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STRUNK | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | JOSHUA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1988 | ||||||||
| Address2: | SUITE100 | ||||||||
| City: | HAZARD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064357642 | ||||||||
| FaxNumber: | 6064365282 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 TOWN AND COUNTRY LANE | ||||||||
| Address2: | |||||||||
| City: | HAZARD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064357642 | ||||||||
| FaxNumber: | 6064365282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2017 | ||||||||
| LastUpdateDate: | 01/05/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3010735 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.