Provider Demographics
NPI:1093577991
Name:BUCKNER, TAYLOR BARNES (PA-C)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:BARNES
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:LYNSEY
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:101 WILLIAM H JOHNSON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2771
Mailing Address - Country:US
Mailing Address - Phone:843-777-7043
Mailing Address - Fax:
Practice Address - Street 1:101 WILLIAM H JOHNSON ST STE 100
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2771
Practice Address - Country:US
Practice Address - Phone:843-777-7043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5194363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant