Provider Demographics
NPI:1881278547
Name:BUCK PURSELL, KATHRYN ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ANN
Last Name:BUCK PURSELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KATHRYN A
Other - Middle Name:ANN
Other - Last Name:BUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-1211
Mailing Address - Country:US
Mailing Address - Phone:615-597-4673
Mailing Address - Fax:
Practice Address - Street 1:301 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-1211
Practice Address - Country:US
Practice Address - Phone:615-597-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3625103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist