Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 1058194 | AL |
NPI | 1013189398 |
---|---|
Provider Name | Kimberly L Buckalew |
First Address | Wedowee, AL 36278-5139 |
Second Address | Wedowee, AL 36278-5139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2008 |
Last Update Date | 27/03/2008 |