Individual
CAROL A BUCKELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
201 S RAILROAD AVE, BROOKHAVEN, MS 39601-3331
(601) 835-0077
(601) 835-0095
Mailing address
201 S RAILROAD AVE, BROOKHAVEN, MS 39601-3331
(601) 835-0077
(601) 835-0095
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R550191
MS
363LA2100X
Acute Care Nurse Practitioner
R550191
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124865
—
MS
Enumeration date
08/17/2006
Last updated
06/18/2008
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