Healthcare Provider Details

I. General information

NPI: 1497581862
Provider Name (Legal Business Name): DEBBIE BUCKLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 OVERLAND AVE
BURLEY ID
83318-2434
US

IV. Provider business mailing address

714 N 1100 E
JACKSON ID
83350-5038
US

V. Phone/Fax

Practice location:
  • Phone: 208-219-4926
  • Fax: 208-878-7073
Mailing address:
  • Phone: 423-641-6439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number71344
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: