Provider Demographics
NPI:1174141477
Name:STRUNK, STACEY
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:STRUNK
Suffix:
Gender:F
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 1535
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-5535
Mailing Address - Country:US
Mailing Address - Phone:606-425-4424
Mailing Address - Fax:
Practice Address - Street 1:1056 S HIGHWAY 27 STE 12
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-2893
Practice Address - Country:US
Practice Address - Phone:606-425-4424
Practice Address - Fax:855-625-0821
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015665363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner