Basic Information
| Provider Information | |||||||||
| NPI: | 1386135416 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUCK | ||||||||
| FirstName: | JENNY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9879 KY ROUTE 122 | ||||||||
| Address2: | |||||||||
| City: | MC DOWELL | ||||||||
| State: | KY | ||||||||
| PostalCode: | 416476026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063773462 | ||||||||
| FaxNumber: | 6063773466 | ||||||||
| Practice Location | |||||||||
| Address1: | 9879 KY ROUTE 122 | ||||||||
| Address2: | |||||||||
| City: | MC DOWELL | ||||||||
| State: | KY | ||||||||
| PostalCode: | 416476026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063773462 | ||||||||
| FaxNumber: | 6063773466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2018 | ||||||||
| LastUpdateDate: | 05/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3012341 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.