Healthcare Provider Details

I. General information

NPI: 1861875445
Provider Name (Legal Business Name): JERI BUCKLEY DNP, ARNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17120 KERCHEVAL AVE
GROSSE POINTE MI
48230-1661
US

IV. Provider business mailing address

17120 KERCHEVAL AVE
GROSSE POINTE MI
48230-1661
US

V. Phone/Fax

Practice location:
  • Phone: 313-886-3300
  • Fax: 313-417-1071
Mailing address:
  • Phone: 313-886-3300
  • Fax: 313-417-1071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704243688
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9301335
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9301335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: