Provider Demographics
NPI:1134329303
Name:BUCK, KARI LEIGH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KARI
Middle Name:LEIGH
Last Name:BUCK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:LEIGH
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:155 CUNNINGHAM LAWRENCE RD
Mailing Address - Street 2:
Mailing Address - City:SHERBURNE
Mailing Address - State:NY
Mailing Address - Zip Code:13460-5106
Mailing Address - Country:US
Mailing Address - Phone:607-674-9392
Mailing Address - Fax:
Practice Address - Street 1:155 CUNNINGHAM LAWRENCE RD
Practice Address - Street 2:
Practice Address - City:SHERBURNE
Practice Address - State:NY
Practice Address - Zip Code:13460-5106
Practice Address - Country:US
Practice Address - Phone:607-674-9392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245602-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02225381Medicaid