Provider Demographics
NPI:1427557339
Name:BUCKNER, CHEYENNE (ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:CHEYENNE
Middle Name:
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:CHEYENNE
Other - Middle Name:
Other - Last Name:SHEETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1609 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-4261
Mailing Address - Country:US
Mailing Address - Phone:405-467-6782
Mailing Address - Fax:
Practice Address - Street 1:1609 W ELM ST
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-4261
Practice Address - Country:US
Practice Address - Phone:405-467-6782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK63482081P0010X
OK10222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer