1659678498 NPI number — AMANDA E BUCKNER LMSW

Table of content: AMANDA E BUCKNER LMSW (NPI 1659678498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659678498 NPI number — AMANDA E BUCKNER LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCKNER
Provider First Name:
AMANDA
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659678498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 273
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67514-0273
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-931-8869
Provider Business Mailing Address Fax Number:
855-514-2738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67514-9701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-931-8869
Provider Business Practice Location Address Fax Number:
855-514-2738
Provider Enumeration Date:
02/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7743 . This is a "LMSW LICENSE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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