Provider Demographics
NPI:1396823183
Name:BUCKLE, ANITA K (APN)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:K
Last Name:BUCKLE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:K
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:7918 VERONA LN
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-5382
Mailing Address - Country:US
Mailing Address - Phone:865-947-0146
Mailing Address - Fax:
Practice Address - Street 1:324 PARK 40 NORTH BLVD
Practice Address - Street 2:STE B
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923
Practice Address - Country:US
Practice Address - Phone:865-692-3462
Practice Address - Fax:865-692-3463
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily