Individual
MRS. JESSICA BLOOM BUCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
61450
WV
367500000X
Certified Registered Nurse Anesthetist
Primary
73554
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810004241
—
WV
01
—
P00274757
R MEDICARE
WV
Enumeration date
10/24/2006
Last updated
09/11/2025
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