Provider Demographics
NPI:1184843773
Name:DAVIS-BUCKLEY, RENSKI (MHPP)
Entity Type:Individual
Prefix:MR
First Name:RENSKI
Middle Name:
Last Name:DAVIS-BUCKLEY
Suffix:
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-4515
Mailing Address - Country:US
Mailing Address - Phone:678-883-8131
Mailing Address - Fax:
Practice Address - Street 1:524 N. CLARK
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923
Practice Address - Country:US
Practice Address - Phone:678-883-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator