Provider Demographics
NPI:1508885112
Name:BUCKNER, NANCY (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:TN
Mailing Address - Zip Code:38007-0038
Mailing Address - Country:US
Mailing Address - Phone:731-334-9994
Mailing Address - Fax:
Practice Address - Street 1:9474 HIGHWAY 78 NORTH
Practice Address - Street 2:
Practice Address - City:BOGOTA
Practice Address - State:TN
Practice Address - Zip Code:38007-0038
Practice Address - Country:US
Practice Address - Phone:731-334-9994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X014OtherBLUECROSS PROVIDER NUMBER
AR5X014OtherBLUECROSS PROVIDER NUMBER