Healthcare Provider Details

I. General information

NPI: 1215479829
Provider Name (Legal Business Name): RACHAEL BUCKLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 E BROWN RD STE 100
MESA AZ
85205-8007
US

IV. Provider business mailing address

4855 E BROWN RD STE 100
MESA AZ
85205-8007
US

V. Phone/Fax

Practice location:
  • Phone: 480-219-6646
  • Fax: 480-219-6647
Mailing address:
  • Phone: 480-219-6646
  • Fax: 480-219-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP9590
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: