Individual
NANCY BUCKNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
9474 HIGHWAY 78 NORTH, BOGOTA, TN 38007-0038
(731) 334-9994
Mailing address
PO BOX 38, BOGOTA, TN 38007-0038
(731) 334-9994
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5X014
BLUECROSS PROVIDER NUMBER
AR
Enumeration date
07/18/2006
Last updated
07/08/2007
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