Healthcare Provider Details

I. General information

NPI: 1508341769
Provider Name (Legal Business Name): BRENDA RACHELLE BUCKNER MSN, RN, CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2483
US

IV. Provider business mailing address

7905 ETIENNE DR
CORPUS CHRISTI TX
78414-6013
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-3660
  • Fax:
Mailing address:
  • Phone: 361-779-2166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number245161
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberAP139078
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: