Provider Demographics
NPI:1477733434
Name:BUCKLEY, ERIN (APN)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 YORKTOWN PLZ
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1424
Mailing Address - Country:US
Mailing Address - Phone:215-600-4590
Mailing Address - Fax:
Practice Address - Street 1:11725 ROE AVE
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-2605
Practice Address - Country:US
Practice Address - Phone:816-319-0731
Practice Address - Fax:816-656-3730
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016005880363LF0000X
KS77200363LF0000X, 363LF0000X
MARN2282382363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
55-0754296Medicare UPIN
IL1477733434Medicare PIN
ILK47718Medicare UPIN
ILK47717Medicare UPIN