Provider Demographics
NPI:1619059177
Name:STRUCKMAN, JONI M (PA C)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:M
Last Name:STRUCKMAN
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:JONI
Other - Middle Name:M
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:SCARBRO
Mailing Address - State:WV
Mailing Address - Zip Code:25917
Mailing Address - Country:US
Mailing Address - Phone:304-465-1378
Mailing Address - Fax:304-469-2981
Practice Address - Street 1:850 INDEPENDENCE ROAD
Practice Address - Street 2:
Practice Address - City:COAL CITY
Practice Address - State:WV
Practice Address - Zip Code:25823-1595
Practice Address - Country:US
Practice Address - Phone:304-469-2905
Practice Address - Fax:304-683-6906
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01260363A00000X
WV454363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810007575Medicaid
WV2028289Medicare PIN
WV3810007575Medicaid
WV2028287Medicare PIN
WV2028288Medicare PIN
WV2028286Medicare PIN