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1013809748 NPI number — REBECCA BUCKNER PHYSICIAN ASSISTANT

NPI Number: 1013809748
Health Care Provider/Practitioner: REBECCA BUCKNER PHYSICIAN ASSISTANT

Information about “1013809748” NPI (REBECCA BUCKNER PHYSICIAN ASSISTANT) exists in 1013809748 in HTML format HTML  |  1013809748 in plain Text format TXT  |  1013809748 in PDF (Portable Document Format) PDF  |  1013809748 in an XML format XML  formats.

NPI Number : 1013809748 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1013809748",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BUCKNER",
    "FirstName": "REBECCA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHYSICIAN ASSISTANT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "12825 VILLA MILANO DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FORT WORTH",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76126-6114",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "817-946-8385",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "450 W MEDICAL CENTER BLVD STE 600",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WEBSTER",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77598-4233",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "832-390-5434",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/17/2025",
    "LastUpdateDate": "07/29/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363AS0400X",
          "TaxonomyName": "Surgical Physician Assistant",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AS0400X",
          "TaxonomyName": "Surgical Physician Assistant",
          "LicenseNumber": "PA19354",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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