Provider Demographics
NPI:1316788631
Name:BUCKLEY, STACY ADAMS (FNP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ADAMS
Last Name:BUCKLEY
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 BOSTIAN RD
Mailing Address - Street 2:
Mailing Address - City:CHINA GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28023-6687
Mailing Address - Country:US
Mailing Address - Phone:980-521-4019
Mailing Address - Fax:
Practice Address - Street 1:1085 NE GATEWAY CT NE STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2411
Practice Address - Country:US
Practice Address - Phone:704-707-2000
Practice Address - Fax:704-707-2203
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRN190351363LF0000X
NC5020723363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily