Provider Demographics
NPI:1588925069
Name:BUCKELEW, SHEENA (CRNP)
Entity type:Individual
Prefix:
First Name:SHEENA
Middle Name:
Last Name:BUCKELEW
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 MEDICAL ARTS COURT, SUITE 2
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-3872
Mailing Address - Country:US
Mailing Address - Phone:334-382-1632
Mailing Address - Fax:334-382-1634
Practice Address - Street 1:45 MEDICAL ARTS COURT, SUITE 2
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-3872
Practice Address - Country:US
Practice Address - Phone:334-382-1632
Practice Address - Fax:334-382-1634
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-117371363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1871003533OtherGROUP NPI
AL511-28407OtherBCBS
AL529906610 GROUPMedicaid
AL529906610 GROUPMedicaid
AL1871003533OtherGROUP NPI