Provider Demographics
NPI:1417269622
Name:BUCKNER, KELLI SUZANNE (DO)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:SUZANNE
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:SUZANNE
Other - Last Name:LITTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:13438 SEBE DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44645-9767
Mailing Address - Country:US
Mailing Address - Phone:303-278-6263
Mailing Address - Fax:
Practice Address - Street 1:16888 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2208
Practice Address - Country:US
Practice Address - Phone:330-323-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.010614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine