MEDICARE: KIMBERLY CHEREE BUCKNER PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	86469	NM
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	3016537	KY
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	6161072	ID
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1054570	TX
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	G173499	IA

General Provider Information

NPI Number	:	1437825767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY CHEREE BUCKNER PMHNP-BC

Provider Business Mailing Address
First Line	:	270 WALRON WAY
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	270 WALRON WAY
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240
Country	:	US
Telephone Number	:	270-886-1919
Fax Number	:

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

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	12/09/2025

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