Provider Demographics
NPI:1437110202
Name:BUCKLEY, KATHLEEN ANN (CPNP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANN
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 MEDICAL DR STE 540
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3755
Mailing Address - Country:US
Mailing Address - Phone:210-575-6240
Mailing Address - Fax:210-575-6280
Practice Address - Street 1:4410 MEDICAL DR
Practice Address - Street 2:SUITE 540
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3755
Practice Address - Country:US
Practice Address - Phone:210-575-6240
Practice Address - Fax:210-575-6280
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX532828363LP0200X
TXAP106709363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ79633Medicare UPIN
TX8J4956Medicare PIN