Provider Demographics
NPI:1255659090
Name:BUCKMAN, JULIE ANN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:BUCKMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:HATCHETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5200 COMMERCE CROSSINGS DR
Mailing Address - Street 2:FL 3
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2182
Mailing Address - Country:US
Mailing Address - Phone:502-253-4924
Mailing Address - Fax:502-489-5750
Practice Address - Street 1:11901 STANDIFORD PLAZA DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-5906
Practice Address - Country:US
Practice Address - Phone:502-969-0526
Practice Address - Fax:502-969-0565
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCV2002433363LF0000X
KY6343P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100160890Medicaid
KY7100160890Medicaid