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NPI Code Detail

MEDICARE: MILLENY BUCKERIDGE NP

MEDICARE: MILLENY BUCKERIDGE NP
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
1363LA2200XAdult Health Nurse Practitioner5024181NC

General Provider Information

NPI Number : 1225829005
Entity Type Code : Individual
Provider Name (Legal Business Name) : MILLENY BUCKERIDGE NP
Provider Business Mailing Address
First Line : 99 GRAPEVINE TRL
Second Line :
City : DURHAM
State : NC
Zip : 27707-5295
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4420 LAKE BOONE TRL
Second Line :
City : RALEIGH
State : NC
Zip : 27607-7505
Country : US
Telephone Number : 919-784-7110
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2025
Last Update Date : 04/02/2026

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