Individual
EBONIQUE MARTIN BUCKNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
768 AVERY BLVD N, RIDGELAND, MS 39157-5219
(601) 487-6482
Mailing address
768 AVERY BLVD N, RIDGELAND, MS 39157-5219
(601) 487-6482
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
903424
MS
Other
Enumeration date
09/10/2019
Last updated
05/17/2021
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