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General NPI Number Information
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NPI Number | 1598036865
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Entity Type | Individual
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Provider Name | JACOB D BUCKLEY CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/19/2012
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 1 HOSPITAL DR SW
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City | HUNTSVILLE
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State | AL
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Zip | 35801-6455
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Country | US
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Telephone | 256-429-5074
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Fax | 256-429-4674
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Provider Business Mailing Address
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Address Line | PO BOX 52404
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City | LAFAYETTE
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State | LA
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Zip | 70505-2404
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Country | US
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Telephone | 256-429-5071
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Fax | 256-429-4674
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | ARNP9257640
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License Number State | FL
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