Healthcare Provider Details

I. General information

NPI: 1184543852
Provider Name (Legal Business Name): VERNIE BUCKNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 N MAIN ST
ROSWELL NM
88201-5012
US

IV. Provider business mailing address

1210 N MAIN ST
ROSWELL NM
88201-5012
US

V. Phone/Fax

Practice location:
  • Phone: 505-274-8534
  • Fax:
Mailing address:
  • Phone: 505-274-8534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2087
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: