MEDICARE: TERRENCE TERRILL BUCKNER

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1134063613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRENCE TERRILL BUCKNER

Provider Business Mailing Address
First Line	:	51266 W HIGHWAY 33
Second Line	:
City	:	DRUMRIGHT
State	:	OK
Zip	:	74030-5708
Country	:	US
Telephone Number	:	918-944-8000
Fax Number	:	918-352-2074

Provider Business Practice Location Address
First Line	:	51266 W HIGHWAY 33
Second Line	:
City	:	DRUMRIGHT
State	:	OK
Zip	:	74030-5708
Country	:	US
Telephone Number	:	918-944-8000
Fax Number	:	918-352-2074

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

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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Directions to “ TERRENCE TERRILL BUCKNER ” Practice Location

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