Provider Demographics
NPI:1598570962
Name:WHITELOCKE BUCKLAND, KAYSIA D
Entity type:Individual
Prefix:
First Name:KAYSIA
Middle Name:D
Last Name:WHITELOCKE BUCKLAND
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5954
Mailing Address - Country:US
Mailing Address - Phone:202-584-9608
Mailing Address - Fax:
Practice Address - Street 1:313 DOUGLAS ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1033
Practice Address - Country:US
Practice Address - Phone:202-584-9608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist