Provider Demographics
NPI:1114575370
Name:BUCKLER, SHAYLA TENNILLE (DNP, APRN, PMNHP-BC)
Entity type:Individual
Prefix:DR
First Name:SHAYLA
Middle Name:TENNILLE
Last Name:BUCKLER
Suffix:
Gender:F
Credentials:DNP, APRN, PMNHP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 MCDONNELL CT
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75167-0006
Mailing Address - Country:US
Mailing Address - Phone:810-610-7262
Mailing Address - Fax:
Practice Address - Street 1:411 N WASHINGTON AVE STE 5200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1778
Practice Address - Country:US
Practice Address - Phone:855-204-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1156843363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health