Provider Demographics
NPI:1043034606
Name:BUCKNER, KIMBERLEY SUE
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:SUE
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815H WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-1119
Mailing Address - Country:US
Mailing Address - Phone:223-339-9600
Mailing Address - Fax:
Practice Address - Street 1:160 N PITT ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-2330
Practice Address - Country:US
Practice Address - Phone:717-275-2854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications