Healthcare Provider Details

I. General information

NPI: 1629513239
Provider Name (Legal Business Name): ROGER JOSHUA STRUNK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 TOWN AND COUNTRY LANE
HAZARD KY
41702
US

IV. Provider business mailing address

PO BOX 1988 SUITE100
HAZARD KY
41702
US

V. Phone/Fax

Practice location:
  • Phone: 606-435-7642
  • Fax: 606-436-5282
Mailing address:
  • Phone: 606-435-7642
  • Fax: 606-436-5282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3010735
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: