Healthcare Provider Details

I. General information

NPI: 1316659220
Provider Name (Legal Business Name): ALLISON LEE BUCK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2022
Last Update Date: 12/22/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BETHESDA DR
GREENVILLE NC
27834-7218
US

IV. Provider business mailing address

300 BETHESDA DR
GREENVILLE NC
27834-7218
US

V. Phone/Fax

Practice location:
  • Phone: 252-752-7141
  • Fax: 252-752-0223
Mailing address:
  • Phone: 252-752-7141
  • Fax: 252-752-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5017392
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: