Provider Demographics
NPI:1366052672
Name:BUCKNER, ANNE CAMILLE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:CAMILLE
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:CAMILLE
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:570 HIGHWAY 321 N
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771-6545
Mailing Address - Country:US
Mailing Address - Phone:865-986-6563
Mailing Address - Fax:
Practice Address - Street 1:570 HIGHWAY 321 N
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-6545
Practice Address - Country:US
Practice Address - Phone:865-986-6563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4196363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant