Healthcare Provider Details

I. General information

NPI: 1902734718
Provider Name (Legal Business Name): AYREONA BUCKNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 FLAG STONE WAY
CLINTON TN
37716-7219
US

IV. Provider business mailing address

139 FLAG STONE WAY
CLINTON TN
37716-7219
US

V. Phone/Fax

Practice location:
  • Phone: 865-621-4063
  • Fax:
Mailing address:
  • Phone: 865-621-4063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number284076
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: