Provider Demographics
NPI:1508341769
Name:BUCKNER, BRENDA RACHELLE (MSN, RN, CPNP-AC)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:RACHELLE
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:MSN, RN, CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:7905 ETIENNE DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-6013
Mailing Address - Country:US
Mailing Address - Phone:361-779-2166
Mailing Address - Fax:
Practice Address - Street 1:3533 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1721
Practice Address - Country:US
Practice Address - Phone:361-694-5320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139078363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical CareGroup - Single Specialty