Provider Demographics
NPI:1477902708
Name:BUCKNER, KATHERINE (MSN, APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:MSN, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 DEVICTOR DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-8666
Mailing Address - Country:US
Mailing Address - Phone:865-679-0058
Mailing Address - Fax:
Practice Address - Street 1:708 DEVICTOR DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-8666
Practice Address - Country:US
Practice Address - Phone:865-679-0058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily