Provider Demographics
NPI:1962276030
Name:BUCKNER, BAILEY (PMHNP)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 FIRE STATION RD STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4071
Mailing Address - Country:US
Mailing Address - Phone:931-820-0242
Mailing Address - Fax:833-551-4830
Practice Address - Street 1:556 FIRE STATION RD STE A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4071
Practice Address - Country:US
Practice Address - Phone:931-820-0242
Practice Address - Fax:833-551-4830
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35143363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health