Provider Demographics
NPI:1396922423
Name:BUCKHEISTER, NANCY A (ADULT ACUTE CARE NP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:BUCKHEISTER
Suffix:
Gender:F
Credentials:ADULT ACUTE CARE NP
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 6190
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-6190
Mailing Address - Country:US
Mailing Address - Phone:228-354-9505
Mailing Address - Fax:228-354-9575
Practice Address - Street 1:10404 TUCKER RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39565-7922
Practice Address - Country:US
Practice Address - Phone:228-354-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR852727363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03630279Medicaid