Provider Demographics
NPI:1104568997
Name:BUCKETT, ANYA (FNP)
Entity type:Individual
Prefix:
First Name:ANYA
Middle Name:
Last Name:BUCKETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 W PLUMB LN STE 101
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3778
Mailing Address - Country:US
Mailing Address - Phone:775-369-2106
Mailing Address - Fax:775-218-4488
Practice Address - Street 1:499 W PLUMB LN STE 101
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3778
Practice Address - Country:US
Practice Address - Phone:775-369-2106
Practice Address - Fax:775-218-4488
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA789473163W00000X
WAAP61339903363LF0000X
NV850287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA789473OtherRN LICENSE