Provider Demographics
NPI:1265785679
Name:BUCKMIRE, JENNIFER (MED)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BUCKMIRE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6462
Mailing Address - Country:US
Mailing Address - Phone:919-784-4696
Mailing Address - Fax:919-784-4697
Practice Address - Street 1:2709 BLUE RIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6462
Practice Address - Country:US
Practice Address - Phone:919-784-4696
Practice Address - Fax:919-784-4697
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6927235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist