Healthcare Provider Details

I. General information

NPI: 1952621807
Provider Name (Legal Business Name): PAULA J RUNYON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA SHERMAN APRN

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 BLACK GOLD BLVD STE 106
HAZARD KY
41701-2620
US

IV. Provider business mailing address

PO BOX 959
HAZARD KY
41702-0959
US

V. Phone/Fax

Practice location:
  • Phone: 606-436-0711
  • Fax: 606-436-0848
Mailing address:
  • Phone: 606-436-0711
  • Fax: 606-435-1322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3006479
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3006479
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: