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NPI Code Detail

MEDICARE: SHAREEN BUCKNER FNP

MEDICARE: SHAREEN BUCKNER FNP
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
1363LF0000XFamily Nurse PractitionerR609536MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841361714
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAREEN BUCKNER FNP
Provider Business Mailing Address
First Line : 5492 FRED HAGUEWOOD RD
Second Line :
City : MERIDIAN
State : MS
Zip : 39301-8413
Country : US
Telephone Number : 601-644-9809
Fax Number :
Provider Business Practice Location Address
First Line : 133 SCANLAN ST
Second Line : LA-Z-BOY SOUTH CLINIC
City : NEWTON
State : MS
Zip : 39345-2329
Country : US
Telephone Number : 601-683-1375
Fax Number : 601-683-4120
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2006
Last Update Date : 11/30/2007

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