| NPI | 1164892204 |
|---|---|
| Former Name | KACEY RAE BUCKNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 300080) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: LA 300080) |
| Enumeration Date | 2015-10-01 |
| Last Update Date | 2023-06-26 |