Provider Demographics
NPI:1093247801
Name:BUFORD, JACQUELINE BOWEN (APN)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:BOWEN
Last Name:BUFORD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:BOWEN
Other - Last Name:BUFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:6670 STAGE RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3810
Mailing Address - Country:US
Mailing Address - Phone:901-384-9000
Mailing Address - Fax:
Practice Address - Street 1:6670 STAGE RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134
Practice Address - Country:US
Practice Address - Phone:901-384-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22366363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN13987984Medicaid