Healthcare Provider Details

I. General information

NPI: 1053714618
Provider Name (Legal Business Name): BRITTANY ANN BUCKMASTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 WORTH ST STE 235
DALLAS TX
75246-2003
US

IV. Provider business mailing address

3410 WORTH ST STE 235
DALLAS TX
75246-2003
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-0434
  • Fax: 214-820-0435
Mailing address:
  • Phone: 214-820-0434
  • Fax: 214-820-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA09475
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: