Provider Demographics
NPI:1386135416
Name:BUCK, JENNY (APRN)
Entity type:Individual
Prefix:MS
First Name:JENNY
Middle Name:
Last Name:BUCK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9879 KY ROUTE 122
Mailing Address - Street 2:
Mailing Address - City:MC DOWELL
Mailing Address - State:KY
Mailing Address - Zip Code:41647-6026
Mailing Address - Country:US
Mailing Address - Phone:606-377-3462
Mailing Address - Fax:606-377-3466
Practice Address - Street 1:9879 KY ROUTE 122
Practice Address - Street 2:
Practice Address - City:MC DOWELL
Practice Address - State:KY
Practice Address - Zip Code:41647-6026
Practice Address - Country:US
Practice Address - Phone:606-377-3462
Practice Address - Fax:606-377-3466
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012341363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner