Provider Demographics
NPI:1801117171
Name:BUCKLEY, KERRY LOUISE (MD)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:LOUISE
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 N BRIDGE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-8882
Mailing Address - Country:US
Mailing Address - Phone:301-537-1680
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL GUANTANAMO BAY
Practice Address - Street 2:PSC 1005 110185
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:34009
Practice Address - Country:US
Practice Address - Phone:757-458-2410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TNMD0000048093207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program