Provider Demographics
NPI:1215062955
Name:BUCKLEY, HEIDI ANN (APRN,BC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANN
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 KENLO WOODS DR
Mailing Address - Street 2:
Mailing Address - City:NASHPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43830-9756
Mailing Address - Country:US
Mailing Address - Phone:740-453-7318
Mailing Address - Fax:
Practice Address - Street 1:5563 RAIDERS RD
Practice Address - Street 2:
Practice Address - City:FRAZEYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43822-9431
Practice Address - Country:US
Practice Address - Phone:740-828-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH081171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily