Healthcare Provider Details

I. General information

NPI: 1295043032
Provider Name (Legal Business Name): JODY-ANN ROXANNE BUCKLE F.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 LAKE ST
NEWBURGH NY
12550-5263
US

IV. Provider business mailing address

2570 ROUTE 9W SUITE 10
CORNWALL NY
12518-1323
US

V. Phone/Fax

Practice location:
  • Phone: 845-563-8000
  • Fax:
Mailing address:
  • Phone: 845-220-3100
  • Fax: 845-534-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF406937
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF336465
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: