Provider Demographics
NPI:1881364552
Name:BUCK, COREY ALLEN (NP)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:ALLEN
Last Name:BUCK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1655 N GLADSTONE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5380
Mailing Address - Country:US
Mailing Address - Phone:812-669-3687
Mailing Address - Fax:812-669-4835
Practice Address - Street 1:1655 N GLADSTONE AVE STE E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5380
Practice Address - Country:US
Practice Address - Phone:812-669-3687
Practice Address - Fax:812-669-4835
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011570A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily