Healthcare Provider Details

I. General information

NPI: 1598488660
Provider Name (Legal Business Name): JENNIFER BUCKLEY DUKE AGACNP-BC FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 13TH ST
GULFPORT MS
39501-2569
US

IV. Provider business mailing address

7 ALEXANDRIA GRACE DR
LONG BEACH MS
39560-4053
US

V. Phone/Fax

Practice location:
  • Phone: 228-861-5255
  • Fax:
Mailing address:
  • Phone: 228-861-5255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number905386
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number905386
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: