Individual
SHAREEN BUCKNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
133 SCANLAN ST, LA-Z-BOY SOUTH CLINIC, NEWTON, MS 39345-2329
(601) 683-1375
(601) 683-4120
Mailing address
5492 FRED HAGUEWOOD RD, MERIDIAN, MS 39301-8413
(601) 644-9809
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R609536
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0118227
—
MS
Enumeration date
11/13/2006
Last updated
11/30/2007
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