Provider Demographics
NPI:1265099303
Name:BUCKNER, SARAH EMILY (RN, AGNP-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:EMILY
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:RN, AGNP-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:DICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1120 MAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-2766
Mailing Address - Country:US
Mailing Address - Phone:636-236-6958
Mailing Address - Fax:
Practice Address - Street 1:1400 US HIGHWAY 61 STE G50
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4142
Practice Address - Country:US
Practice Address - Phone:314-366-4874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009023414163W00000X
TXAP140436363LA2200X
MO2018034003363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse