Individual
MISS ANGLE RENEE BUCKLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2514 WESLEY ST STE 102, JOHNSON CITY, TN 37601-1764
(423) 631-0236
(423) 631-0237
Mailing address
2514 WESLEY ST STE 102, JOHNSON CITY, TN 37601-1764
(423) 631-0236
(423) 631-0237
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APRN0000014399
TN
363LF0000X
Family Nurse Practitioner
Primary
APRN0000014399
TN
363LP2300X
Primary Care Nurse Practitioner
APRN0000014399
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4243703
BLUECROSS BLUESHIELD
TN
Enumeration date
12/16/2008
Last updated
05/16/2011
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