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General NPI Number Information
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NPI Number | 1083279723
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Entity Type | Individual
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Provider Name | LAURA BUCKLEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/08/2019
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Last Update Date | 05/08/2019
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Provider Practice Location Address
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Address Line | 99 CENTRAL AVE
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City | ASHLAND
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State | OR
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Zip | 97520-1787
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Country | US
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Telephone | 541-482-7799
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Fax |
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Provider Business Mailing Address
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Address Line | 101 DEMOCRACY ST APT 108
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City | YORKTOWN
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State | VA
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Zip | 23693-5672
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Country | US
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Telephone | 757-897-7507
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA192432
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License Number State | OR
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