Provider Demographics
NPI:1831873850
Name:BUCKNER, JOANNA (NP, RN)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:NP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11190 COUNTY ROAD 309
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75161-6738
Mailing Address - Country:US
Mailing Address - Phone:770-312-0745
Mailing Address - Fax:
Practice Address - Street 1:11190 COUNTY ROAD 309
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75161-6738
Practice Address - Country:US
Practice Address - Phone:770-312-0745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1068920363L00000X
TX862447163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner