Healthcare Provider Details

I. General information

NPI: 1700266558
Provider Name (Legal Business Name): BUCKLEY PARKER P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 UNION AVE.
MEMPHIS TN
38104-6727
US

IV. Provider business mailing address

1455 UNION AVE.
MEMPHIS TN
38104-6727
US

V. Phone/Fax

Practice location:
  • Phone: 901-726-6655
  • Fax: 901-666-8437
Mailing address:
  • Phone: 901-726-6655
  • Fax: 901-666-8437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2797
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: