Physician Compare National (NPI:1548517113)

HEALTHCARE PROVIDER:

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1548517113
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3173772209
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20121005000315
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BUCKNER
	Individual professional last name
Provider First Name	ANGELA
	Individual professional first name
Provider Middle Name	LOUISE
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2012
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	517 RUSSELL ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE C
	Group Practice or individual's line 2 address
City	DUNLAP
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	373273649
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M