Most Relevant Information
Provider Data
| NPI Number: | 1003465352 |
| Provider Name: | EBONIQUE MARTIN BUCKNER NP-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 903424 |
Most Important Dates
| Enumeration Date: | 09/10/2019 |
| Last Updated: | 05/17/2021 |
Provider Practice Location
768 AVERY BLVD N
RIDGELAND
MS
391575219
Practice Location Phone/Fax
| Phone: | 6014876482 |
| Fax: |
Provider Mailing Location
768 AVERY BLVD N
RIDGELAND
MS
391575219
Provider Mailing Phone/Fax
| Phone: | 6014876482 |
| Fax: |