Healthcare Provider Details

I. General information

NPI: 1740965748
Provider Name (Legal Business Name): KOURTNEY ANN STRUB PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KOURTNEY ANN BAKER PA

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 W POPLAR AVE
PORTERVILLE CA
93257-5839
US

IV. Provider business mailing address

257 MCDOWELL ST
ASHEVILLE NC
28803-2606
US

V. Phone/Fax

Practice location:
  • Phone: 342-687-7960
  • Fax:
Mailing address:
  • Phone: 828-258-1121
  • Fax: 828-252-6114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16662
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: