Provider Demographics
NPI:1093252041
Name:BUCKNER, RICKY HOWARD
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:HOWARD
Last Name:BUCKNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 GOLDSMITH LN STE 143
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2091
Mailing Address - Country:US
Mailing Address - Phone:502-249-3945
Mailing Address - Fax:502-631-9660
Practice Address - Street 1:213 MANDALAY RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1332
Practice Address - Country:US
Practice Address - Phone:270-403-7708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker