Provider Demographics
NPI:1194183350
Name:BUCKLEY, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7107 W. 12TH ST., STE 201
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-6676
Mailing Address - Country:US
Mailing Address - Phone:501-519-1415
Mailing Address - Fax:501-325-7938
Practice Address - Street 1:7107 WEST 12TH STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-6676
Practice Address - Country:US
Practice Address - Phone:501-519-1415
Practice Address - Fax:501-537-2718
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator