Provider Demographics
NPI:1629513239
Name:STRUNK, ROGER JOSHUA
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:JOSHUA
Last Name:STRUNK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1988
Mailing Address - Street 2:SUITE100
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702
Mailing Address - Country:US
Mailing Address - Phone:606-435-7642
Mailing Address - Fax:606-436-5282
Practice Address - Street 1:101 TOWN AND COUNTRY LANE
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41702
Practice Address - Country:US
Practice Address - Phone:606-435-7642
Practice Address - Fax:606-436-5282
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010735363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner