Provider Demographics
NPI:1508436718
Name:BUCKLEW, FEVEN ZEGEYE (NP)
Entity Type:Individual
Prefix:
First Name:FEVEN
Middle Name:ZEGEYE
Last Name:BUCKLEW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:FEVEN
Other - Middle Name:ZEGEYE
Other - Last Name:HABTERUFAEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:809 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5321
Mailing Address - Country:US
Mailing Address - Phone:318-393-7382
Mailing Address - Fax:
Practice Address - Street 1:979 N COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5783
Practice Address - Country:US
Practice Address - Phone:817-625-4254
Practice Address - Fax:817-378-0861
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1045873363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily