Provider Demographics
NPI:1356138358
Name:BUCK, KELSEY (FNP-C)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:BUCK
Suffix:
Gender:
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 1:3500 N MOUNT JULIET RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3059
Mailing Address - Country:US
Mailing Address - Phone:615-758-5672
Mailing Address - Fax:
Practice Address - Street 1:3500 N MOUNT JULIET RD STE 201
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3059
Practice Address - Country:US
Practice Address - Phone:615-758-5672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38675363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily