Individual
JENNIFER COLLIER BUCKLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGACNP-BC FNP-BC
Contact information
Practice address
4500 13TH ST, GULFPORT, MS 39501-2569
(228) 861-5255
Mailing address
14964 MITLEY LN, SAUCIER, MS 39574-7221
(228) 861-5255
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
905386
MS
363LF0000X
Family Nurse Practitioner
905386
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
90538
MSBON
MS
Enumeration date
09/22/2022
Last updated
09/22/2022
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