Larry R Buckley, PA-C, MPA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

112148 Issued in MO

Practice address

600 Blues Lake Pkwy
Rolla, MO 65401-8022

Phone

(573) 364-8822

Fax

(573) 341-5969

NPI assigned

Oct 19, 2005

Last updated

Nov 17, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258416000000",
    "number": "1356330542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 BLUES LAKE PKWY",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654018022",
            "telephone_number": "573-364-8823",
            "fax_number": "573-341-5969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 BLUES LAKE PKWY",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654018022",
            "telephone_number": "573-364-8822",
            "fax_number": "573-341-5969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "LARRY",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "PA-C, MPA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-19",
        "last_updated": "2009-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "112148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelcie Brunnert, CRNA, DNAP
• Raymond E. Bruno, FNP
• Edward A Bruns, DO
• Melinda Bryson, RN, FNP-C
• Dawn Michelle Buchanan, RN, MSN, NP-C
• Kiera Buggest, RN
• Kourtney Buhler, DNP-FNP, APRN
• James T Burdett, MD
• Lisa M Burmeister, CRNA
• Joyce A Burns-Holland, LSW

• Physician Assistant in Rolla, MO
• Providers in Rolla, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.