MEDICARE: KIMBERLY G BUCKNER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN246985	OH

General Provider Information

NPI Number	:	1043540685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY G BUCKNER RN

Provider Business Mailing Address
First Line	:	7905 LONDON PLATTSBURG RD
Second Line	:
City	:	SOUTH CHARLESTON
State	:	OH
Zip	:	45368-9707
Country	:	US
Telephone Number	:	937-631-9412
Fax Number	:	937-568-4341

Provider Business Practice Location Address
First Line	:	7905 LONDON PLATTSBURG RD
Second Line	:
City	:	SOUTH CHARLESTON
State	:	OH
Zip	:	45368-9707
Country	:	US
Telephone Number	:	937-631-9412
Fax Number	:	937-568-4341

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2010
Last Update Date	:	01/08/2010

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