Provider Demographics
NPI:1386255289
Name:BUCKNER, CALVIN L II
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:L
Last Name:BUCKNER
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:VAN
Mailing Address - State:WV
Mailing Address - Zip Code:25206-0313
Mailing Address - Country:US
Mailing Address - Phone:304-245-8163
Mailing Address - Fax:
Practice Address - Street 1:12340 CHAP RD
Practice Address - Street 2:
Practice Address - City:GORDON
Practice Address - State:WV
Practice Address - Zip Code:25093-9427
Practice Address - Country:US
Practice Address - Phone:304-245-8163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant