Provider Demographics
NPI:1760859995
Name:BUCK, CONNIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:BUCK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 E BARNETT RD STE H
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8383
Mailing Address - Country:US
Mailing Address - Phone:541-789-8176
Mailing Address - Fax:541-778-9614
Practice Address - Street 1:1010 SW COAST HWY STE 203
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-5215
Practice Address - Country:US
Practice Address - Phone:541-265-4947
Practice Address - Fax:541-574-7670
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY15987-1395363LF0000X
MT99694363LF0000X
OR201901366NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily