MEDICARE: FEVEN ZEGEYE BUCKLEW 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
1	363LF0000X	Family Nurse Practitioner	1045873	TX

General Provider Information

NPI Number	:	1508436718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FEVEN ZEGEYE BUCKLEW NP

Provider Business Mailing Address
First Line	:	809 STRATFORD DR
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-5321
Country	:	US
Telephone Number	:	318-393-7382
Fax Number	:

Provider Business Practice Location Address
First Line	:	979 N COOPER ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-5783
Country	:	US
Telephone Number	:	817-625-4254
Fax Number	:	817-378-0861

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

Provider Enumeration Date	:	06/29/2021
Last Update Date	:	07/25/2022

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