Provider Demographics
NPI:1396359758
Name:BUCKNER, CHEYEANNA DAWN
Entity Type:Individual
Prefix:
First Name:CHEYEANNA
Middle Name:DAWN
Last Name:BUCKNER
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:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:NELLIS
Mailing Address - State:WV
Mailing Address - Zip Code:25142-0091
Mailing Address - Country:US
Mailing Address - Phone:304-590-7164
Mailing Address - Fax:
Practice Address - Street 1:1435 FORK CREEK RD
Practice Address - Street 2:
Practice Address - City:NELLIS
Practice Address - State:WV
Practice Address - Zip Code:25142
Practice Address - Country:US
Practice Address - Phone:304-590-7144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant