Provider Demographics
NPI:1043208838
Name:BUCKLES, MARLA DIANNE (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:DIANNE
Last Name:BUCKLES
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Gender:F
Credentials:FNP
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Mailing Address - Street 1:208 W CASABLANCA AVE
Mailing Address - Street 2:27 MEDICAL GROUP BLDG 1400 CANNON AFB
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-5014
Mailing Address - Country:US
Mailing Address - Phone:505-784-6605
Mailing Address - Fax:505-784-6028
Practice Address - Street 1:208 W CASABLANCA AVE
Practice Address - Street 2:27 MEDICAL GROUP BLDG 1400 CANNON AFB
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88103-5009
Practice Address - Country:US
Practice Address - Phone:505-784-6608
Practice Address - Fax:505-784-6028
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2007-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX241753363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily