Healthcare Provider Details

I. General information

NPI: 1346175841
Provider Name (Legal Business Name): CORRINE ELAINE BUCKNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W COATES ST STE 2
MOBERLY MO
65270-1574
US

IV. Provider business mailing address

1323 WATSON AVE
MOBERLY MO
65270-1123
US

V. Phone/Fax

Practice location:
  • Phone: 660-414-0107
  • Fax:
Mailing address:
  • Phone: 660-414-0107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: