Provider Demographics
NPI:1982279907
Name:BUCKHALTER, AMBER MARIE (HIS)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:BUCKHALTER
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MARIE
Other - Last Name:CRYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2102 MACARTHUR DR STE C
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3763
Mailing Address - Country:US
Mailing Address - Phone:318-484-3755
Mailing Address - Fax:318-484-3499
Practice Address - Street 1:2102 MACARTHUR DR STE C
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3763
Practice Address - Country:US
Practice Address - Phone:318-484-3755
Practice Address - Fax:318-484-3499
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSHA-695237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty