Healthcare Provider Details

I. General information

NPI: 1487595955
Provider Name (Legal Business Name): RENA SHARNETTE BUCKKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8808 BELL RIDGE DR
OLIVE BRANCH MS
38654-6222
US

IV. Provider business mailing address

8808 BELL RIDGE DR
OLIVE BRANCH MS
38654-6222
US

V. Phone/Fax

Practice location:
  • Phone: 662-444-5066
  • Fax:
Mailing address:
  • Phone: 662-444-5066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number00211982
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: