Provider Demographics
NPI:1043072150
Name:BUCKEY, TERRY
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:BUCKEY
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 1:340 SHANNON DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-9006
Mailing Address - Country:US
Mailing Address - Phone:704-310-0289
Mailing Address - Fax:
Practice Address - Street 1:340 SHANNON DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-9006
Practice Address - Country:US
Practice Address - Phone:704-310-0289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21830513172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver