Provider Demographics
NPI:1952621807
Name:RUNYON, PAULA J (APRN)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:J
Last Name:RUNYON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:SHERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-0959
Mailing Address - Country:US
Mailing Address - Phone:606-436-0711
Mailing Address - Fax:606-435-1322
Practice Address - Street 1:210 BLACK GOLD BLVD STE 106
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-2620
Practice Address - Country:US
Practice Address - Phone:606-436-0711
Practice Address - Fax:606-436-0848
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006479363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100127880Medicaid
KYK216260Medicare PIN
KY7100127880Medicaid