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General NPI Number Information
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NPI Number | 1013809748
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Entity Type | Individual
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Provider Name | REBECCA BUCKNER PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 450 W MEDICAL CENTER BLVD STE 600
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City | WEBSTER
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State | TX
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Zip | 77598-4233
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Country | US
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Telephone | 832-390-5434
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Fax |
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Provider Business Mailing Address
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Address Line | 12825 VILLA MILANO DR
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City | FORT WORTH
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State | TX
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Zip | 76126-6114
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Country | US
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Telephone | 817-946-8385
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA19354
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License Number State | TX
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