Provider Demographics
NPI:1124215090
Name:BUCKLEY, MELANIE DENISE (PA)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:DENISE
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 DAMONTE RANCH PKWY
Mailing Address - Street 2:SUITE 703
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5912
Mailing Address - Country:US
Mailing Address - Phone:775-398-4600
Mailing Address - Fax:775-398-4606
Practice Address - Street 1:500 DAMONTE RANCH PKWY
Practice Address - Street 2:SUITE 703
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5912
Practice Address - Country:US
Practice Address - Phone:775-398-4600
Practice Address - Fax:775-398-4606
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1059363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPA1059OtherPA LICENSE
CAPA19322OtherPA LICENSE