Provider Demographics
NPI:1598171563
Name:BUCKNER, STEPHEN J (APRN)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:BUCKNER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:7430 JEFFERSON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-6159
Practice Address - Country:US
Practice Address - Phone:502-966-8675
Practice Address - Fax:502-966-8836
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN18526363LF0000X
KY3017310363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily