Healthcare Provider Details

I. General information

NPI: 1376136705
Provider Name (Legal Business Name): DR. KIMBERLY A. BUCKNER, P.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 02/17/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 J F GREEN ST
SANDY HOOK KY
41171-7134
US

IV. Provider business mailing address

PO BOX 85
SANDY HOOK KY
41171-0085
US

V. Phone/Fax

Practice location:
  • Phone: 606-738-5545
  • Fax: 606-738-5405
Mailing address:
  • Phone: 606-738-5545
  • Fax: 606-738-5405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KIMBERLY ANNE BUCKNER
Title or Position: OWNER
Credential: DMD
Phone: 606-738-5545